50 & dense but BRCA negative
Hi -- I just joined today and as such am rather overwhelmed by all these different topics, so I hope I am posting in the correct forum.
I am fifty years old. My Mom and maternal aunt are breast cancer survivors.
I have always had dense breasts. My doc recommends MRIs in addition to mammograms. Last year an MRI result was abnormal so I had an ultrasound biopsy, which was benign.
Several months ago I was tested for BRCA 1 @ 2 and came out negative (my Mom was negative as well). I recently had an abnormal mammogram followed by a Mammotome biopsy (extremely difficult and painful), which was benign as well.
The Gail Model says my lifetime risk is about 1 in 4, but since I am menopausal with dense breasts, I understand that increases my risk but I'm not sure by how much -- I've heard it might double, which would put my lifetime risk at 1 in 2.
I am seriously considering prophylactic mastectomy followed by reconstruction. I am considering surgery much more than taking either Tamoxifen or Reloxifene because I've read that either drug would reduce my risk by about 50% while surgery is supposed to be a 90-95% reduction (which is what I've read in medical literature).
I understand that surgery is permanent and has side effects such as nerve damage and implant replacement, but both drugs can have serious side effects as well (such as stroke or joint damage), and do nothing to prevent estrogen negative breast cancer.
My doc agrees with me that surgery is a viable option, but her privileges are limited to one hospital, and that hospital does not have good reconstructive plastic surgeons. She is therefore encouraging me to look elsewhere for a surgical team.
My questions are as follows:
1. Is my decision making process on the right track? Have I overlooked anything significant?
2. How can I find a good surgical team -- a regular surgeon and a plastic surgeon?
3. What else should I be doing/reading/etc? (I realize that is a very vague question but what else do I ask when I don't know what else to ask?)
Comments
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Hi kittygirl. The first thing I would ask is if you had BRCA testing with a Certified Genetics Counselor, or some other professional? A CGC should be able to give you a pretty good idea about your risk.
I was 52 when I found out that I am BRCA2+. I had prophylactic surgery. You are negative, but it seems a reasonable option since there is obviously something going on in your family. A CGC should give you a little more clarity, but ultimately, it is about what YOU decide.
I strongly recommend that you read Kathy Steligo's Breast Reconstruction Handbook before any consults. Generally, the Breast Surgeon and the Plastic surgeon are a team, so you get the best results. Ask for patients willing to speak with you about their procedures. If you decide on a breast surgeon, they will recommend a PS. If you know the procedure you want, and a PS who does it, s/he will recommend a BS they work with. But you need to feel comfortable with your team.
I also recommend that you try the website www.facingourrisk.org. Even tho you are not BRCA+, there is a family thing there, and many women on that site are in your same position. There is SO much educational and emotional support there. Depending on where you live, there may be some recommendations for Dr.s and/or support groups in your area.
Best of luck, and feel free to send me a PM if you want to know more.
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Hi there, I got a really nice skin-sparing bilateral mastectomy from Dr.Robert Foster at UCSF. I highly recommend him. My breasts look and feel very natural. Two important thing about mastectomies: you lose feeling in your reconstructed breatss and nipples, and they put the implant under you pectoral muscle so activities using your pec muscle are never the same (e.g. the breast stroke in swimming.) Other than those two things, I'm happy with my new breasts! I always had really tender and painful breasts that never wanted to be touched, so the mastectomy is an improvement on the touchiong front. Breast massage feels good and is needed with my new ones.
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Hi tweekerbeeker -- I saw breast cancer oncologists who did my Gail Model and the BRCA test (well they sent the blood sample to a lab) so I figure they are pretty experienced in that area. I had consults with both of them about my risk and they discussed both Tamoxifen and Reloxofene with me. These discussions were prior to my most recent biopsy, though.
Where can I find Kathy Steligo's Breast Reconstruction Handbook? Can I buy it in a bookstore? Is it online? Also thank you for the web links.
(EDITED TO ADD) -- I looked up the oncologists I saw and while their bios don't say they are "certified genetics counselors" they do have a specialty in genetics counseling for women at risk for breast cancer.
Hi Sea_nymph -- thank you for sharing your story -- which raises a question I was somewhat embarassed to ask about, but I suppose this forum is the right place to ask it -- does the loss of feeling affect yours (well, anyones) sex life? I am married and am somewhat concerned about that. Also, does the change in pec muscles affect normal activities such as lifting a bag of groceries, pulling a suitcase through an airport, or picking up something from the floor above a certain weight (whatever the weight is?)
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kittygirl, I have some sensation in my breasts. It is very individual-no one can tell if or how much you will regain. I find a very light touch to be very sensual! The most important sexual organ is the brain!
I bowl, swim, and play volleyball. I bag and lift groceries into a cart for my customers at a grocery store! About the only thing I don't do is worry about BC!
I got Kathy Steligo's book from my local library. It shouldn't be hard to find as it is like a reconstruction BIBLE.
If you post on the facingourrisk site, and ask for recommendations of surgeons in your area, I am sure you will get some good results. Good luck!
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Hi tweekerbeeker, thanks for your reply. Did you get implants in your reconstruction? If so, what kind and how do you like them? And how long have you have them?
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hi again kittygirl. I had a lat flap with expanders(which I had no problems with) and then exchanged them for Mentor moderate profile silicone implants. I have had the actual implants 5 months. It feels a little weird if I run or bang into something, but I really do like them. I do not feel like I am carrying around weights. They feel like my own breasts to me.
What kind of recon are you considering? Your PS ids so important. Mine is a true artist, but it took me a long time to trust him-now I know that he knows better than me!
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Hi tweekerbeeker, I was considering Nipple Sparing Mastecomy (NSM) with implants, using Alloderm in a one-step surgery (I think that is the correct terminology, is that right?). I am not sure about the type of implants. I've heard the new "gummy bear" silcone implants do not leak and feel more natural than the ones filled with saline.
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- kittygirl, NSM is a great recon. However, not too many doctors do a nipple-sparing, fewer a one-step. Depending on where you live, you may have to travel for the surgery. I live in a very cosmopolitan area and the docter's I interviewed asked "what is Alloderm?"!!!
- My understanding is that the gummy bears are only available in trials in the US. Perhaps I have not kept up.
- I would suggest that you start a new thread, asking for people who have had a NSM one-step in your state-or elsewhere. Keep in mind that the results of a one-step might be better if you are not large breasted.
- Again I would refer you to www.facingourrisk.org There are MANY women there who have had this type of surgery and recon, and can direct you to some of the top doctors in the country.
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Hi kittygirl,
Sounds like you've gotten a lot of great advice. I'm in sort of the same situation. I am having problems. Have already had a partial MX and a very strong family hx. I can't afford BRA testing, and when i talked with genetic counselor i asked what would happen if it came back negative if i did have it. She told me, that it probably would be considered an uninformative negative b/c of family hx. Anyway, i'm have a BMX in January. But that has been my own decision from day one and hasn't wavered, even though i've been open about researching other options. Part of that of course is because my LB already looks awful, and my sisters took medication and both stopped b/c of side effects. They have to have biopsies almost every year, and both said next time, they're just going to get MX's.
I think you have to be really really comfortable with your decision. So good luck to you. Whatever works for you works.
Marian
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Hi tweekerbeeker, thanks for the info. I will take a look at the the website you recommended.
Hi moonbuddy, thanks for posting, and good luck with your January surgery -- are you having reconstruction as well?
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KittyGirl,
I can no longer pull sails on a sailboat (with strength), swim the breaststroke, or do push-ups. I even notice the pectoral weakness when scrubbing burnt stuff out of pans. Also, when I'm naked, there are certain body positions that cause my implants to scrunch and look flat, wrinkled, and unnatural (due to pectoral muscle contraction). I wished someone had warned me about that from the beginning, just so I could be prepared. However, IT IS SO GREAT not to have to worry about any remaining breast tissue as a potential playground for breast cancer. The benefit most certainly negates the drawbacks. My partner loves the way my implants look and feel. You can get a beautiful reconstruction. It is very important to get an excellent plastic surgeon though!!!!!!!!!!! If you are considering this, make that your number one task/challenge.
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Kitty Girl - you can get a lot of the same information that is in that book right here on the internet and at breastreconstruction.org. Where do you live? It is best to gather all the information you can from a breast surgeon and a plastic surgeon. I have seen 2 BS and I am seeing a PS this wk. I can let you know what I find out, as I am hoping for skin sparing, direct to implant to get peace of mind. I need to move on with my life!
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Thank you Sea nymph and Kimber --
I will go visit that web site and also will interview PS to see what is available and what the results look like.
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Hi all I wanted to update --
I have a consult with a PS this week and have taken your advice to heart, to ask a lot of questions and read a lot of information.
My husband is opposed to the surgery because at the moment my breasts are healthy with all biopsies being benign. His position is of course causing me additional stress (in addition to the basic stress of being high risk).
I have heard that there are other models for assessing BC risk besides the Gail Model, has anyone heard of other models and if they are more or less accurate than the Gail Model?
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