Immediate reconstuction (DIEP) with IBC dx?

Faith, like Bonnie, I had bilateral mastectomies. I had a Total on the right non-cancer breast and a Modified Radical in the left IBC breast with 11 lymph nodes removed (4 were positive).  That was followed by 35 rounds of radiation to the upper left quadrant of my chest & shoulder area. When talking with docs re reconstruction, they encouraged me to wait until after radiation because of the potential skin damage ... I got 2nd degree burns from radiation which left some scars. Reconstruction would now take care of those, but I still don't want it because of my personal concern with the high risk of local recurrence in skin or chest walls.  My oncologist is totally in agreement with my decision, although she can't recommend one way or the other. Besides - it's fun having different size prosthetics for different activities! One of my IBC buds had Tram-Flap at time of mastectomy, her radiation didn't bother it (but she's olive-skinned).   Karen

(I'm still diggin')

The kicker may be "the biopsy of the removed tissue establishes clear margins"...at some facilities, it may take up to a week to completely examine the tissue.  My best understanding is that if the margins are not clear, the solution is re-excision (or rads...no rads for you.)

There is no doubt in my mind that re-excision would complicate / possibly compromise the reconstruction.  I am not a microsurgeon..I got my non-existent medical degree at Screw U.

Having personally had 2 flap surgeries (my first attempt failed), I assure you, m'am...it's not something you would want to do twice.

The balance to the kicker may hinge on what facility you are treated at.  (University type hospitals tend to have faster labs.  I seem to wait much less time than many of my cancer friends.)

tl 

Faith,

I also had immediate reconstruction.  I think its fairly common now.  I had mine at MD Anderson in Orlando.  Go to diepsisters.com and there is some good info plus a list of diep docs.  Make sure your surgeon is experienced in the procdedure as it is a complicated microsurgery.  PS who specialize in breast augmentation are NOT the same!

Well, HALLALUJAH!  (I am so happy to hear that you are being treated at one of the top facilities in the country, Miss Faith.  )  I know that worrying about the ladies on the breast cancer pages is not what I should be doin'...but, sometimes, I just can't help myself.    Glad to know that you are in good hands.

Whereas aggressive locally advanced disease is a bugger to treat, I think it is possible to clean it up...at least, that's what I got my own money riddin' on.

It does "make sense" to me that you are having the mastectomy as a "preventive" measure...not that you need my approval...just sayin'...plus the dermal lymphatics thing stacked on top of it tends to make it a done deal.

That is actually what I chose for myself.  (In the odd event that I should actually survive this crap...I don't want a new one, and that is absolutely positively for certain.)

Please keep us posted.

 tl 

Hi Faith-  I had my initial dx and staging done at MD Anderson. Have IBC.  I had a modified radical mastectomy.  The MD Anderson docs all advised to wait one year before doing any reconstruction due to the high rate of recurrence. I had most of my treatment locally, including surgery.  My local docs all said just wait until your skin has healed from radiation, at least six months.  Hard to know what to do.  

Hi Bonnie-  If I win the lottery I will be at MDA every 3 months.  I'm trying to determine how frequently I can make it down there. My local oncologist doesn't do any scans unless symptoms.  He seems pretty hard core with that.  He's told me why and it sounds so logical and reasonable while I'm in his office.  And then I get home and  I cannot wrap my head around that concept.  Dr. Cristofanilli would do PET/CT scan at least every six months and some sort of a brain scan within a year.  A radiologist would argue that the sooner we find a brain met, the better chance we have of zapping it and you getting on with your life.  I guess I'll see if it is harder to go without scans or actually harder to have the scans and be freaking out waiting for results.  Neither option sounds like a fun time to me.  I am not on Zometa.  (I'm thinking I should be. I've had a bruise like feeling on my spine since the same time of my dx but according to PET/CT and bone scan, not cancerous.  xray showed beginnings of osteoarthritis.  This is so weird, I'm 39 and perfectly healthy other than this cancer.)  I think I need a new local oncologist.  I have spent time researching different things lately and don't feel like I can really talk to my oncologist in any meaningful way about what I've learned and what I think I might want, but need the guidance of an oncologist to help me sort it out. It would save me a lot of money to get a better fit with a local oncologist than to keep flying down to Texas, but if I ever get a recurrence, I really don't want anyone else to draw up my treatment plan other than one of the major cancer centers, period. 

Correction:  Early detection does not improve survival time for mets; it may, however, improve survival in the event of a new primary.

http://cme.medscape.com/viewarticle/590039;meddomainjsession=m7B6KwhQ1L9yCT1NRT5BVXrjL8KR3hj3L4hGFZRCJP4xxQJmRLyX!2000943616

"Detection of second breast cancers in the asymptomatic phase leads to detection of early-stage cancer and improves relative survival by between 27% and 47%," the study authors write.