Just diagnosed with extensive DCIS

Ok, I have seen the surgical oncologist today. Also, final pathology report came back hormone receptor positive.

He wants an MRI, he said that due to the extent of the cancer (he said over 60% of the breast) he is not sure at this point it is just DCIS. He wants the other breast checked as well. He said, best case scenario,  right mastectomy with IR, worst case scenario, bilateral MX with chemo and (if necessary) radiation, with the reconstruction done in about three months from the MX.

I am supposed ot have the MRI next week, so I will put an update here. 

Sorry, I will post more tomorrow, I am very tired right now and need some time to rest.

thank you for all your support, hugs to all.

Day

Yes, I figured that out. I do have already scheduled the appointment with the PS for Tuesday afternoon. After looking more on it, I think i might lean more towards the DIEP. Anyway, it will all be depending on what the MRI shows. I do have quite a bit of fat on my tummy - I had to go hypo-thyroid and put on some weight before I was given Radioactive Iodine in June, to kill my thyroid, because I was supposed to go with no anti-thyroid medication for a while.

Oh yes and I forgot, the final pathology report showed that my cancer is hormone receptive, so the oncologist said I will have to take Tamoxifen for 5 years.

The waiting is what is the worst thing. I do have a lot of moral support, and it is amazing, in times like these, you discover how much people actually do love you.

I had the MRI yesterday - so it's the "hurry up and wait" game again until Wednesday or Thursday. I have been seriously considering to have the bilateral even if my left breast shows clear.

I also had the PS appointment a few days ago. The PS said that he is not keen on the TRAM flap or even the DIEP -as they both have the danger of abdominal hernia down the road. He also said that what the mammogram shows has good chances that there will be skin-sparing when the mastectomy will be done, and if I choose the bilateral and the left breast is clean then there will be skin and nipple sparing for it (and the breasts will look more "matched" as well). If nevertheless the MRI (or pathology) will show invasion, and I'll need radiation, then he will go with the dorsal flap - he said in his experience it has the best recovery rate and (unless you're a pro tennis player or swimmer) presents the less discomfort.

So, rightnow, while waiting for the final results, I'm just taking one day at a time. I am blessed with great friends and absolutely priceless SO - and that helps a lot.

rubybuttons, great to know that if there's only DCIS than Tamoxifen might not be required. My endocrinologist was a little worried about that - as my hyperthyroid had thetendency to "leak" the calcium off my bones - I'm on a "special diet" of Vit D and calcium for over an year and a half now.

As soon as i know more, I'll post.

Hugs for all, and thank you for all the support.

Day

FreedomFaith,

I will go with the latissimus dorsi only if I have to go through radiation - as the skin on the mastectomy site would be affected by the radiation and wouldn't be able to be used for expansion. That would be only in the "worst case scenario", i.e., if the cancer is invasive and I have to go through radiation and chemo - that would put the reconstruction at about three months after the mastectomy. You can't have radiation on an existing implant. 

In the "best case scenario" that will be just that - IR with memory gel silicone, not even with expander because I only want the same size cup I have now - C - and the DCIS affected area is far from the skin, so the skin would be spared.

Ok, MRI results are in. The area affected by DCIS in my right breast is bigger than what the mammogram had shown - the oncologist said about 10 cm. There is a suspicious area of about 6 cm in my left breast as well, he wanted to go for an ultrasound and an MRI-assisted biopsy, but I told him that we should just go ahead and do a bi-lateral.

Now the good news: the MRI doesn't show invasion or lymph node involvement (he said though that can only be 100% certified at the mastectomy after the pathlogy). And due to my cancer location, he will be able to do skin, areola and nipple sparing for both breasts (he will only remove the core of the nipple).

The surgery will be sometime mid-October, because the PS needs to order "my new boobs". I'll keep updating as soon as I find out more.

Ok, I'm getting paranoid and freaking out again.

I had just received in the mail the MRI report. Copying from it:

There is irregular nodular mass enhancement involving the majority of the upper-outer quadrant of the right breast which does extend over the midline, as well as into the inferior quadrants measuring 10.1 cm in greatest dimension. This does extend to the base of the right nipple. This does correlate with the distribution of the microcalcifications on outside imaging. These findings are consistent with multicentric ductal carcinoma in situ. The right internal mammary and axillary basin appears fee of lymphadenopathy.

In addition involving the left superior breast extending into the inferior quadrants, is similar irregular enhancement measuring 6.2 cm in greatest dimension. While this patient is premenopausal, the morphology of the enhancement is not consistent with benign proliferative change. The left nipple-areolar complex appears free of abnormality. The left internal mammary and axillary basin appears free of lymphadenopathy.

Impression:

1) Irregular nodular enhancement within the right breast measuring 10.1 cm in greatest dimenSion. This does occupy the majority of the upper-outer quadrant of the right breast and does extend across the midline, as well as into the inferior quadrant consistent with multicentric ductal carcinoma in situ. This distribution does correlate with the expansive microcalcifications on outside imaging.

2) Irregular enhancement involving the majiroty of the left superior breas measuring 6.2 cm which extends slightly into the inferior quadrants. This is not characteristic of benign proliferative change, even though this patient is premenopausal. Left breast ultrasound is recommended. If noncontributory, MRI-guded left breast biopsy will be recommended.

3) No evidence of lymphadenopathy.

BI-RADS category 6: known biopsy - proven malignancy - appropriate action should be taken.

ARE THEY SAYING THAT WHATEVER IS IN THE RIGHT BREAST IS INVASIVE????

I know, I know, but it seems so hard to believe that I have that size of an area involved without any invasion. Suddenly all the small aches and pains I had in the last couple of years start getting new meanings. I've been beating myself over the head for not having a mammogram last year, until my oncologist said that with the high density breasts I have it wouldn't have shown, probably - same as it didn't show anything in my left breast in this last mammogram, and the MRI found an area bigger than 6 cm! I'm wondering for how long I've had it.