Chemo first, then Mastectomy

Hi, Everyone ~
Ok, I saw the onco today (Jan 19), and we are definitely doing chemo before surgery.  And, joy of joys, after poking around my armpits, he said he wasn't concerned about nodes and said nothing about SNB!  Yay!!  Now I can put the fear of nipple injections behind me!

Onco did order a PET scan and an echocardiogram.  The echo must be standard procedure since he didn't even listen to my heart, and I have no (known) problems with it. 

The PET has gotten me a little shaken since I learned that cancer can spread even if there's no node involvement.  I won't have that scan until Friday the 23rd, so there will continue to be much swallowing of Xanax until I have those results.

I will be getting a port Jan 22nd; I've been assured I'll be sedated for that, so I'm not too nervous about that.

So, if everything goes as planned, I should be starting chemo next week.  While it's not something I look forward to, I am glad that we will finally be doing something!  

Blessings to you all,
Artemis

I am having a SNB day after tomorrow and now I am scared out of my mind reading about them putting a needle in my nipple.  My breast surgeon showed me physically that they would insert the needle right up next to the outside of my nipple.  He also told me that I would not be put "under" for this part of the procedure as then I would be under anesthesia longer than he wants me to.  HELP!  I can't take a valium either that morning since they are putting me under.

Ok, back to the original thread.  I responded days ago but that was before I had a treatment plan in place.

Like Deb and some others I am having chemo first.  4 rounds of AC then 4 rounds of Taxol.  The idea is to shrink my tumor from 4CM to something small enough to where I can get a lumpectomy.

The reason for the SNB prior to chemo is to know if I have cancer in my lymph nodes before chemo kills them.  At least that is my understanding.  Also the radiologist insisted on this procedure first so that she would not have to radiate my underarm area for no reason at all if my nodes are negative.

After surgery I will have 6 weeks of radiation.

I think there are great reasons to do chemo first as others have stated above.

Awesome news debbie!  I know how you feel   I too had really good results with neoadj chemo, but I still went for the mastectomy.  Good luck with your surgery!

Hi, lovemy3girls ~
Thank you for your lovely and encouraging post.  I will make a mental note to fully appreciate the sedatives for the port placement, and I hope I get a bit of the refreshment and relaxation that you did.

Artemis

hi all, i am also doing chemo first in hopes to shrink my tumor.  My doc gave me the choice but what clenched it for me they said they would not have given me the chioce if one was a lesser treatment. they said cure rates were equal enough to do either. so while i am still strong and not trying to recover from surgery lets do chemo first and start kicking butt.

mentors a great company.  our rep does alot for our patients, great implants as well, but so is naturelle.  I kinda think you should get the verdict on the adriomycin before proceeding with the swap.  the only reason i say this is because i had adriamycin (with cytoxin) after my surgery and i ended up with an infection that was impossible to deal with during treatment.  I ended up in the hospital and on IV antibiotics and then on antibiotics for weeks by mouth and had to have the d@#! drain put back in, then yet another infection, that's when they popped my expander! and more antibiotics!  Not Fun!  Then again, I had a mastectomy and not just an exchange, nonetheless it's still an invasive procedure.  How are feeling after the herceptin?

6 wks sounds pretty good-definately err on the side of caution.  Listen to your gut about that one.  Did your surgeon give you a choice as to whether you could choose smooth or textured?  We usually do not give a choice-it's pretty much up to surgeon preferance.  "they say" that there is less chance of capsular contracture with the textured implants, MAYBE by 2-4%(very small)  That would be a question for you PS-"what's your capsular contracture rate?"  Our surgeon pretty much only uses smooth and we don't see that complication very often. hope that helps!  I'm glad your tolerating herceptin well.  I get wiped out as well, but can't tell if it's from the herceptin or just emotionally draining. 

ejlj- first tx was 1/16 have another friday, don't know if it is working, if how crummy i feel is any hint then it is.

I'm new here, 28 years old, and newly diagnosed and I am here looking for info on having chemo first, which is what my docs recommend.  Thank you so much all of you for sharing your stories and information.  It's helping me feel more secure in this decision to do chemo before the surgery.  I'm still getting all those pre-chemo tests and scans done, but I should be starting within a few weeks.  I'll definitely be coming back here to learn from all of you.

I did chemo first to try and shrink the tumor(s) but ended up getting a mastectomy anyway because it was then detected that I also had DCIS in the same breast.  The chemo did shrink my tumor to nothing though after 3 treatments (of 6 TCH), the u/s I had subsequently showed nothing detectable as cancer at all!  I also had a breast MRI before this decision was made.  I am glad I did chemo first as it made the surgery seem like a piece of cake.  Chemo is hard but doable though....

Hi Everybody.  Nice not to be alone in this boat.  Stupid cancer.

I will probably use some terminology that is incorrect because I'm learning as fast as I can.

I'm not staged yet.  I'm 49, I felt a lump in right breast, Feb 26 this year, had it needle biopsied March 10, was positive, 1.7cm.  Oncologist called for an MRI, that revealed another nodule in the left breast, ultrasound biopsy couldn't find it, so did biopsy with MRI scan technology.  It was positive too - about 0.7cm.  It is a distinct and different cancer, not the first lump having spread. 

I wanted a PET scan and LNB to figure some things out for myself, but my team kept explaining that a good course of action was immediate lumpectomy surgery combined with LNB then we could check the margins, get me staged, etc.  Just had that surgery last Tuesday.

(Side note about the nipple injections, not a pleasant thing, but there is local anesthesia in the injection as well, so it's only the initial surprise that gets ya.  They feel like a slight bee sting because the liquid is going right under the skin rather than into deeper tissue.  A good breathing technique will get you through it.  I had both my breasts done at once - they try to do it quickly.  I was glad two doctors were seeing to it simultaneously so I didn't have to wait for 8 consecutive shots!  Still - not a picnic.)

Here's what my surgery results revealed:  the margins on both sides were not good (that second margin was a surprise, because that's the one that looked smaller and "very well defined" in all the images.)  I was pretty disappointed about that, but I know I want to have the double mastectomy now, rather than play around with trying to get all the cancer out.  I think my breasts are trying to tell me something.

There is good news (fantastic news, really) - I was negative for cancer in all the biopsied lymph nodes.  I hope that means it isn't spread?  But I still wish my doctor would recommend some scans to alleviate this worry.

I don't like my oncologist - he doesn't listen or explain things well and is kind of dismissive.  And he's what they call my "lead" doctor.  I love my surgeon, who takes the time to listen, though I know he's heard the questions a million times before.  He remembers things about how I think and what kind of person I am and considers my individuality when I ask his advice about things.

I have to meet with my medical oncologist two days from now (Friday) and discuss options.  He has already said that if the LNB proved negative, he would still recommend chemo.  I wonder why?  He may have been thinking because the original course was lumpectomies instead of double mastectomy?  I think I remember him saying chemo first, then mastectomy.  Why in that order if I'm not trying to shrink lumps to prepare for lumpectomy surgery?

Can anyone shed some light?

Also, Annette, I feel your money woes and fears.  I am currently employed, have decent health insurance, but my firm is downsizing and I fear being left out there uninsurable with a preexisting condition.  I may lose my hair from worrying before the chemo gets a chance to attack it!

It's frankly another reason I am opting for mastectomy instead of keeping battling what's left of these lumps.  I may not have the insurance coverage to keep monitoring the situation much longer - I just need to do as much as I can while I can. 

Good health to all of you dear ones.  Sorry this is so long.

Evelyn, sorry about all the troubles you are going through.  But it sounds like you are getting good care, etc.  Hope the questions you have about chemo, etc., will be answered.  It may be that having the cancer in both breasts raises some flags about possible spread.  It only takes one cell floating around to cause later problems, and chemo would help minimize those chances of spread.

Janet, you did not mention how large the tumor was.  I had chemo first, then the mastectomy.  My whole breast and underarm were involved.  They said there was no way they could do surgery first withut having the tumors shrunk down first.  I also had the MRI and bone scan done before starting chemo.  Had the PET scan after chemo and surgery. 

Thanks for responding, Nelia48.  So you don't think it's strange to start with chemo even if they know beforehand that you'll have a mastectomy?   One of my tumors is 2 1/2 cm and the other is about 1 cm.  How are you doing today?  I just scheduled the MRI and Bone Scan... I'm worried, the odds haven't exactly been working in my favor lately.  (I can't even believe I'm saying this stuff about myself)