DCIS, BMX/MX, and radiation ladies

I don't think you are alone...I am still trying to decide what treatment option to have for my DCIS.  I am waiting for more biopsy tests from last Thursday.  I am leaning toward mastectomy but would love to hear how you came to your choice.   I meet with the plastic surgeon this week to discuss options while waiting for the results. 

beesie - we've missed you!

Julianna - glad it's going well.  I think I felt the fatigue the most after I was done!  My PT person said the affects of radiation generally peak 3 months AFTER you finish!  I think she was right though.  

Hello ladies!I'm 31 years old, single mom & I have just been diagnosed with Grade 2 DCIS....at least for now, my MD says my diagnoses may or may not change after we get the final path from the mastectomy. I've opted for bilateral for peace of mind. I have an appointment with a PS next Friday to discuss reconstruction options. Although my MD does not feel that radiation will be needed, I'm worried that may change after final diagnoses. What have your experiences been? Reconstruct immediately vs. Delayed reconstruction? Does radiation damage the TE?

julianna51

did your surgeon give you the choice between the diep flap and TE's?  I feel that I want the TE, but the surgeon seems to be pushing me towards the diep flap as i will be having radiation.....Just curious to know what your surgeon's opionion was?

thanks

Hi Kim137 - you and I seem to be in similar places right now. I was diagnosed with DCIS, grade3. Choosing BMX for peace of mind also. Told that if DX doesn't change I won't need radiation.  My fingers are crossed that my lymph nodes come back negative. I'm scheduled for surgery 10/7 and having tissue expanders put in at the same time. My PS said just in case I end up needing RADS she saves the Latissum flap as a backup. 

Dear julianna51 - My wife is at the decision point of mastectomy and immediate reconstruction versus lumpectomy and radiation.  Both options include sentinel node biopsy.  The biopsy report is DCIS, Grade 2, some comedo necrosis with suspicion of microinvastion, ER positive, PR negative.  The BC surgeon estimates from the mammogram that the DCIS covers 25 to 35 percent of the breast.  We were told that 10 percent of mastectomy patients will require radiation and 20 to 30 percent of lumpectomy patients require a second lumpectomy.  Taking this all into account, my wife prefers the mastecomy and hoping for the best.  I will continue to read your thread and good luck.  My wife's surgery will be some time in October.

Juliana51- this is a great thread! After receiving the news today that my sentinel node biopsy showed isolated cell micro metastasis, the reality of radiation may be hitting me all to soon! I too thought I could get thru the BMX, TE and exchange and move on with my life....seems it may be more complicated than just that. My MD told me not to fret, that it could be cells from my previous biopsy. We won't know anything until after my BMX 10/13. I was a little concerned that he says we will not do an axillary node dissection, but instead wait for the path report from my breast tissue and nodes removed from breast/chest area. Apparently there is a great deal of controversy over this....lucky me! Ugh! Wish I could just have a "simple" diagnoses....lol! ( I realize the ridiculousness in that statement!)

Hi all, 

As of now my BS is not recommending rads, but I am getting a second opinion on my pathology.  My DCIS covered ~60% of my breast and the report says the DCIS appeared close to the posterior resection margin "however, evaluation is difficult due to cautery artifact."  There is no mention of how many mm of margin is there.  So I will know more after my second opinion, but thought I'd do a little research ahead of time, just in case.

Beesie - I read your post: "However over the past few years there have been studies that have shown that recurrence risk can increase substantially for those who have close margins after a MX for DCIS."  Would you mind sharing the links to those studies, if you have them handy?  If not, I'll go find them - just thought if you had them handy it would save me some research work.  Thank you!    

And Juls, did you share your story of why you needed rads?  Didn't see the details above - was it due to close margins, and if so, how close were yours?  Thanks!   Oh, and I would love to hear anyone else's story of why they needed rads after MX/BMX for DCIS.  

Hey everyone I just found a nice summary of the article I just posted, written by the American Cancer Society.  

Conclusions: What did the researchers say their study results mean?

Patients with margins of 2 mm or less who have any additional unfavorable features such as having high-grade disease, comedonecrosis or being under the age of 60 are at particular risk of local recurrence and might benefit from radiotherapy after mastectomy. However, additional research is needed to confirm these findings.

It is thought that half of local recurrences will be additional DCIS and half invasive cancers, this belief by other long term studies of breast cancer. However, in this small sample, looking at these special parameters, all the cases of local recurrence were invasive. This makes the recurrence more dangerous.

https://www.cancerfacts.com/home_studyreport.asp?cb=266&litid=374 

Julianna - thanks for the reply!  I finally got my slides sent from Miami via fed ex this morning - my Alabama docs should have them by tomorrow so then it will just be some waiting until I get their second opinion on the path.

My experience with microfat grafting has been great so far.  I had my first graft done at the same time as my BMX.  The PS did lipo suction from the front of my thighs and then injected the fat in small aliquots into my pectoralis major muscles to form a small breast mound.  Right now I would say I have about an AA.  I had lots of pain in my thighs from the lipo, especially the first 24 hours, but it was worth it!  I will have 2 or 3 more lipo/grafting procedures before I get to the size I want.  They can only inject a certain amount of fat at one time b/c they need a matrix (scaffold of tissue with blood supply) to inject into so that the fat survives.  The pec muscle serves as that matrix for the first surgery; for the next surgeries I have to wear a special device called a Brava that expands the tissues and creates the scaffold for the next grafting.  It is a big time committment (wear it 10 hours a night for 4 wks), so you have to know what you are getting into.  I'm really happy so far - my results are very natural with very few scars.  I was afraid of implants and did not qualify for DIEP (not enough stomach fat), but I have enough leg fat for the microfat procedure, so it made sense for me. (sorry for the thread hijack!) 

Julianna - are you done with rads?  I think you must be so congrats to you!  Remember to keep stretching especially now that you're done!  How long is your ps telling you to wait before your exchnge?

Julianna - so glad to hear you are doing so well after rads!