Received DCIS Diagnosis - Doctor Visits - Comments Invited
PLEASE GO TO NEW THREAD "Received DCIS Diagnosis - Doctors Visits - IT JUST GOT WORSE - Comments Invited". ORIGINAL THREADS "Received DCIS Diagnosis - Comments Invited" and "Received DCIS Diagnosis - Doctors Visits - Comments Invited".. Today my wife and I had our visit to the BC surgeon. We also got lucky and met with a reconstructive surgeon. First of all my wife is in excellent spirits and asked a lot of questions. The BC surgeon's opinion was the following: (1) DCIS per the mammogram films which I saw with my own eyes is present in an estimated 25 to 35 percent of the right breast - whether it is Stage 0 or Stage 1 can only be determined after surgery; (2) two surgical options and the pros and cons of each were laid out in detail - lumpectomy and SNB plus radiation or masectomy plus SNB. The BC surgeon said that in this case she would recommend 60 percent toward mastectomy and 40 percent toward lumpectomy. Other topics discussed were BRCA (not necessary because no family history), HER2 (will be done after some or all of the right breast is removed, MRI (deemed unncessary - mammograms and biopsy are enough for BC surgeon), recurrence risk (lumpectomy option 10 percent recurrence risk and mastectomy 2 percent recurrence risk), survival rates (98 percent with Stage 0 and 90 to 95 percent with Stage 1), Tamoxifen (that will come later) and chemotherapy (only if SNB is positive). The BC surgeon also said that with the presentation of my wife's DCIS, if the lumpectomy option is chosen there would be a 30 percent chance of not being able to obtain clear margins requiring a second lumpectomy or even a mastectomy after the lumpectomy. The reconstructive surgeon laid out in great detail two breast reconstruction options - (1) silicon or saline breast implant using allograph or (2) stretching the latissimus dorsi muscle to reconstruct the breast - the so-called flap. So my wife is thinking about the mastectomy versus lumpectomy option and leaning toward the mastectomy option. Lower recurrence risk and avoiding radiation are the key factors in her thinking. In terms of the breast reconstruction, I feel like I need to do more reseach. I was well prepared for the BC surgeon and not as knowledgeable for the reconstructive surgeon. My wife feels comfortable with both doctors so far. Any comments on lumpectomy versus mastectomy and on breast reconstruction options and experiences would be greatly appreciated. And I must say that all the information that I received on this bulletin board greatly prepared me for the visits today - the BC surgeon complimented me on asking good questions (and so did my wife).
Comments
-
I'm glad that the appointments went well. And it sounds as though your wife is dealing with this very well.
I believe that someone previously provided a link to an earlier post that I wrote that laid out the pros and cons of lumpectomy vs. mastectomy. If you can't find it, I'd be happy to repost. There are, obviously, lots of pros and cons to each option so in the end it all comes down to what's most important to your wife, and which option better addresses her needs and concerns.
There is one thing that I want to point out. While in most cases radiation is not required after a mastectomy for DCIS, if it should be found that your wife has invasive cancer and is node positive, then radiation may be required even if she has the mastectomy. Also, if it turns out that there is more DCIS than expected and if the DCIS is right up against the chest wall, then even without having nodal involvement or invasive cancer, radiation might be required after the mastectomy. There is a discussion thread about this in the DCIS forum right now. It's rare but it can happen. One of the benefits of having an MRI is that MRIs are usually (but not always) more effective at showing the whole area of cancer. This can make the lumpectomy vs. mastectomy decision easier - for me, it told me that I really had no choice but to have a mastectomy because the DCIS was spread through out my breast, something not seen on the mammogram. An MRI can also help indicate whether radiation may be a possibility after a mastectomy. If your wifes choose to have a mastectomy hopefully radiation won't be required, but she should not make this decision assuming for sure that it won't be. I've seen too many women who've been surprised after surgery to get this news.
-
Hi Beesie - Welcome to my new thread. The BC Surgeon today said that with a Mastectomy there is "usually" no radiation. Later she qualifed that as "ten percent" of her mastectomy cases needed radiation. So we understand that with a mastectomy, there is a 10 percent chance of needing radiation but usually it is not required. If the SNB is positive, then the BC surgeon said chemotherapy may be needed first followed by radiation (I may be confusing the order). The BC surgeon laid out the possibility that with a lumpectomy, there was about a 30 percent chance that she would not be able to achieve "clear margins". My wife's thinking for leaning toward a mastectomy as I understand it is a combination of avoiding multiple surgical operations (the mastectomy and breast reconstruction would all be done during the same operation), lowering but not eliminating the need for radiation, and reducing the recurrence risk from 10 percent to 2 percent. The BC surgeon also gave my wife a copy of The Breast Cancer Treatment Handbook and I was greatly encouraged to see her reading it. I need to get more insights into breast reconstruction. The breast reconstruction surgeon explained things in detail but I had not done any research on breast reconstruction so I felt the discussion on breast reconstruction (for me) was a bit overwhelming as opposed to the visit to the BC surgeon where I felt well-informed. The breast reconstruction surgeon laid out the possible complications such as infection, pain and so forth. Anyway, I can see the change in my wife including higher spirits, her asking the doctors questions, reading the BC Treatment Handbook. She still does not want to be on the bulletin board and she does not want to tell her side of the family or our children. But there was a lot progress made today. Thanks again for your post.
-
I had MRI which shown I have 2 small satellite lumps which is important as I was opting for lumpectomy. If you opt for mastectomy, then it's probably less critical. My insurance only cover MRI as part of the operation procedures. So i have to check in hospital 2days in advance to do it.
good luck!
-
Dear aquaclara - It is my wife that would make the decisions. I am her husband and doing the research and going to the bulletin board. My wife has started reading the Breast Cancer Treatment Handbook. I see you are from Hong Kong. I work in Hong Kong and China and come home to the US once a month. I know Hong Kong very well. I can speak Mandarin and some words of Cantonese. I will be home for several weeks whenever my wife has her surgery and recuperation. "Do Jay" (thank you in Cantonese) for your post.
-
BlairK, the implant option for reconstruction will involve more than one surgery. In addition, though the recurrence odds for lumpectomy are greater, the survival odds for it plus radiation versus mastectomy are the same.
It is also the case that the mastectomy is a much more invasive operation, and recovery sometimes much more challenging. Do look for Beesie's wonderful list of pros and cons.
.
-
Dear Tarry - Thanks a lot for your post. It is my wife's decision. I will pass on to her what I am learning.
-
Reconstruction may not involve more than one surgery. In some cases a one step reconstruction is possible. I understand this works best for those who don't want to go too big. I had this done with a nipple sparing bmx. Caryn
-
Your wife should strongly consider having the MRI before closing the door on her options. It is one more piece of information, and unfortunately, breast surgeons bring their own biases into this . . . and no offense, but from what you wrote, your wife's dr. most certainly seems to be leading your wife toward a mastectomy. While a dr. may be playing the odds, they are odds nonetheless (and the only thing that matters is your wife's situation not the odds anyway), and there is no restoring what is removed, so why not get a complete picture?
I had BRCA testing and an mri, and only when both came back fine did my bs and I agree that the right decision was a lumpectomy -- he was conservative and brought up mast. in our initial meeting but "considered" my wanting to preserve the breast and sensitivity so sent me for the additional testing, which also was good because it gave me a chance to wrap my head around all of this. My lumpectomy was sizable, and many others have posted the same, but it is amazing how things just sort of settle back even, so please do not have her panick and feel as though she must choose a mast. because she'd be deformed from a lumpectomy -- I'm not and I'm not alone, and rads really weren't a big deal, they are far scarier than the phyiscal reality.
These are such personal decisions, and whatever she ultimately chooses/does, there must be no regrets, because you cannot undo what is done and must have inner peace. I have never for one day wished I chosen mx or bmx (which was also under consideration until I got the BRCA results back) and although I am a little nervous each year when I have my mammograms, I am happy to have that one sleepless night for the 364 others.
Wishing your wife and you all the best.
-
I'm not comfortable with a surgeon who recommends against a pre-surgical MRI, but that's just me.
Why a lat flap and not the more common DIEP or TRAM flaps? Has your wife had prior abdominal surgery? There are several additional types of flap surgeries, with the tissue coming from different donor sites.
From what I've read, it seems unusual for any mastectomy & reconstruction procedure to be truly "finished" in one surgery. It seems as if having a "revision" surgery to correct defects left by the first surgery is VERY common.
And then there's the discussion of nipple sparing or not.
-
It's great to hear that your wife's spirits are up - I'm sure your presence has contributed to that!
Re the mastectomy vs the lumpectomy - I had the lumpectomy first, margines weren't clear and microinvasion was discovered so I had a mastectomy. I had wanted a nipple sparing one but I wasn't a good candidate for it. Sure enough, the pathology report after the mastectomy showed that the DCIS was in my nipple as well.
In spite of having 2 surgeries, I was glad I had a lumpectomy first because I knew that I had tried to save my breast. In the end though, I was ok about a mastectomy.
I haven't had reconstruction. I still hope to one day - would love to use the fat cell/scaffolding technique which is still in the trial stages. If not that, I think I would have DIEP.
-
i just had my lumpectomy today and it went well. i got a clear margin. the way my surgeon approached its she started w the lumpectory and snb, they wld test the lumps immediately to make sure the margin was clear. if not, she would do additional cut. only under the condition the wound was too big or the breast was too disfigure, she would do the mastectomy.
the above approch is based on the the dcis are found in same area if there are spreading in a few places it may be difficult to do lumpectory. thats when mri plays an important role to determine if there are small dcis found in other place.
on the reocurrance rate, my doc said its around 5% for dcis if patient is followed up with radiation but for those dont have radiation will increase to 30%.
finally since you live in china, you may be interested to learn how to eat for cancer patient in china, like no shrimp, crab, duck, beef and milk. chinese thinks those type of meat are "toxic", i think in western nutrition, they are too high protein. also avoid grill, stir fry. i was also told only eat organic chicken and eggs because others are loaded with hormones. hope your wife will get well soon!
-
Some info on indications/guidelines for breast MRIs. If you click on the titles of the articles, they are (or should be) links to the actual articles.
1.Screening
b. Screening of the contralateral breast in patients with a new breast malignancy
MRI can detect occult malignancy in the contralateral breast in at least 3% to 5% of breast cancer patients.2. Extent of disease
a. Invasive carcinoma and ductal cardinoma in situ (DCIS) - Breast MRI may be useful to determine the extent of disease and the presence of multifocality and multicentricity in patients with invasive carcinoma and ductal carcinoma in situ (DCIS). MRI can detect occult disease up to 15% to 30% of the time in the breast containing the index malignancy. MRI determines the extent of disease more accurately than standard mammography and physical examination in many patients. It remains to be conclusively shown that this alters recurrence rates relative to modern surgery, radiation, and systemic therapy.b. Invasion deep to fascia - MRI evaluation of breast carcinoma prior to surgical treatment may be useful in both mastectomy and breast conservation candidates to define the relationship of the tumor to the fascia and its extension into pectoralis major, serratus anterior, and/or intercostal muscles.
.
Breast cancer staging is based on the extent of local-regional disease in the breast and axilla, which has predictive value regarding the patient's prognosis and dictates treatment options. Breast MRI, when combined with mammography and clinical breast exam, has been shown to provide sensitivity of 99% for the preoperative assessment of the local extent of disease in patients with newly diagnosed breast cancer. This is compared with sensitivities of 50% for clinical breast exam, 60% for mammography and 83% for ultrasound alone. Breast MRI has consistently been found to detect additional unsuspected malignancy within the ipsilateral breast, with numerous studies identifying this in 0% to 27% of patients.
Tumor size is also more accurately depicted with MRI vs. mammography when correlated with pathologic specimens. Occult, synchronous, contralateral breast cancer is also identified in approximately 3% of patients. Although long-term information is not yet available, the intended and potential benefits of using breast MRI in these patients include: decreasing the number of surgeries required to obtain negative surgical margins, decreasing breast cancer recurrence rates, and improving long-term survival....
While there is no definitive evidence at this time that MRI is more appropriate for certain subgroups of patients with newly diagnosed breast cancer, there is evidence to suggest that breast MRI may be particularly helpful in certain situations. This includes patients who have
dense breast tissue, invasive lobular carcinoma, extensive ductal carcinoma insitu (DCIS) and those who will be treated with neoadjuvant chemotherapy.Dense breast tissue may obscure signs of malignancy on mammography and limit the evaluation of the true extent of disease. In fact, Berg et al. found the sensitivity of mammography to decrease in proportion to increases in mammographic breast density, while breast density did not affect the sensitivity of MRI.
Both invasive lobular carcinoma and tumors with an extensive component of DCIS are often underestimated by mammography. Obtaining negative surgical margins with breast conservation therapy for these tumors is often challenging. In the past, MRI has been considered limited in the evaluation of DCIS. However, more recent studies have found MRI to be superior to mammography in detecting unsuspected DCIS. Thus, these patients may benefit from more accurate assessment of the extent of disease preoperatively using MRI.
.
I had my surgery years before the most recent information about the benefits of MRIs was published, yet my surgeon sent me for an MRI anyway. His feeling was simply that he wanted to go into the operation knowing as much as he possibly could about the extent of the cancer. The fewer surprises, the better. He also didn't want me to have any more surgery than necessary - and that's a good reason to have an MRI done on both breasts. In my case, the MRI showed extensive "stuff" (which couldn't be confirmed as being cancer until after the operation, but which we were pretty sure was more DCIS) in my right breast, but it also showed my left breast to be totally clear, despite the fact that I'd just had a biopsy for calcifcations (benign result) and several previous biopsies. That made me very comfortable with the decision to have a single mastectomy rather than either a lumpectomy or a bilateral mastectomy.
.
As for reconstruction, I agree with the others who've noted that your wife's PS did not mention all the options. Here are some good websites with information about reconstruction:
http://www.breastcancer.org/treatment/surgery/reconstruction/
http://www.cancer.org/Cancer/BreastCancer/MoreInformation/BreastReconstructionAfterMastectomy/index
-
Can't speak to the MRI but agree that the reconstruction options are greater than what your ps presented. I was pretty much convinced I wanted one step reconstruction with implants when I saw my ps for the first time. Still, he insisted, and rightfully so, that I listen to all of the options and then decide. Additionally, he was very clear that regardless of what I wanted up front (no pun intended) what was found during the surgery itself would be the final arbiter of what was possible. i.e.One step and nipple sparing (what I wanted) might not be possible if medical considerations trumped cosmetic desires. So happy to hear that your wife is doing well. All of us approach this journey in different ways but I think the most important thing is to keep moving forward (this doesn't mean there won't be times when we move backwards!). Caryn
-
Hi BlairK....I was thinking of you and got on the board today to hopefully see your progress from the Doc visit yesterday. As you may remember, I also had a meeting with my Doc.
I am SO very happy to learn that your wife is feeling in better spirits! If she'd like to privately message me, I would love to support her through this since we are both in the same boat right now. I understand though if she is a private person and won't want to. She is probably feeling very relieved right now after talking over the options and having a course of treatment. I certainly feel better myself!
I am choosing a bilateral mastecomy since the diagnostic MRI showed atypical cells in the other breast. I don't want to have a unilateral mastectomy(right), and lumpectomy/radiation (left). It just doesn't make sense (to ME) and I don't want to wait and see if anything progresses to cancer cells later. I have never been a gambling type person and I am opting for the side with the greatest odds of no reoccurence. I will be having tissue expanders with reconstruction at the time of mastectomy with silione implants down the road. This is my choice but I realize it may be a choice someone else in my shoes wouldn't make. Oh well...that is why it is MY journey not theirs.
Even driving home after discussing the options, I felt a huge weight lifted to know that my decision was made. I have considered all options, risks, and complications and do not go in blindly. I am so happy that you are here now for your wife. It probably helps her spirits just having you back in the States!!
"Do Jay" for your support, BlairK.
-
Thank you for all the posts. The information is appreciated but overwhelming. We went to yet another doctor today - our internist. I can safely use the word "our" because he takes care of both of us. He seemed very knowledgeable about breast cancer and breast cancer treatments. My wife is very comfortable with the BC surgeon (the BC surgeon is a woman). However, I am going to push the BC surgeon to have an MRI and let my wife know that this is my opinion. What harm can it do and it may provide more valuable information. The advice we were given was to get a second opinion on the reconstructive surgery. So my wife will visit next week a second reconstruction surgeon and compare the impressions of the two and the various options. A type of implant called "gummy" implant was mentioned as an option. This can be put in without a "tissue expander". The second reconstruction surgeon has the capability of performing this type of breast reconstruction. We were told that not too many breast reconstruction surgeons in the US know how to do this type of reconstruction. I am going to start to do research on it. The abdominal flap options are not an option for my wife. She is thin and does not have much abdominal fat. Again, I was really encouraged to see my wife reading the "Breast Cancer Treatment Handbook" and she is asking a lot of questions. I guess the first week she was in shock but now she seems in high spirits and ready to deal with this. My wife seems to want to avoid radiation treatments but realizes that with a mastectomy there is a small chance that radiation would still be necessary. Again, Beesie posted useful information on the MRI. I am going to push for my wife to have a MRI and also my wife thinks it may be a good idea.
-
I'm sure Blair is too polite to mention whether his wife has small, medium, or large breasts, but my feeling is that breast size is probably relevant to the decision of MX versus lumpectomy when one is talking about a tumor that's 25 to 30% of the breast.
I agree that an MRI is relevant, if only to determine whether their might be undetected cancer in the other breast.
And the only other comment I wanted to add to all the excellent ones here is that there seem to be more discussions about various MX and reconstruction options over in the "Surgery - Before, During, and After" area, where they're talking about TEs, DIEP, trans-flaps, and all kinds of stuff I hope never to have to investigate.
Congratulations to Blair and his wife for getting this far and for asking all those good questions!
-
Another thing is to keep in mind is that implants are, as I understand it, perishable. I seem to remember being told that they were expected to last for 10 years? 20 years? and would then likely have to be replaced. This may be a factor worth discussing depending on your wife's age.
Depending on where you live, your wife might (if she wants) be able to meet with women who have had breast reconstruction, take a quick visit to the ladies' room and peek at their breasts. This is a very common thing to do, and it may help her in deciding what sort of reconstruction she wants - assuming she's going to have a mastectomy.
-
Actually, Blair, I just realized there's a whole "Breast Reconstruction" section here on BCO! I'd suggest you check it out.
-
Blair, the "gummy" implant has been used for years in Canada and Europe - and I think Asia and Australia & New Zealand too but I'm not sure - it's mostly the U.S. that has not been using it. I believe that the gummy is the implant used most around the world. It is the most cohesive of all implants and therefore presents the lowest risk of leaking/spreading, should there be a rupture in the shell of the implant. Gummies have been in test in the U.S. for quite some time; the problem for patients over the past few years has been finding a PS who is in the trial and who still has some of his/her allocation left for new patients. I'm a few months out of date but last I checked, the two brands of gummy implants, Allergan and Mentor, had not yet been approved by the FDA. Assuming that's correct, it means your wife is fortunate to find a PS who is in the clinical trial and who has open slots.
When you see the PS, you might want to ask about whether your wife will be in the gummy clinical trial (again, assuming that the FDA approval has not come through over the past few months). Some PSs in the U.S. say that they use gummies but in fact they use the standard implants that all PS use in the U.S.. These implants are also cohesive, but they are not "highly cohesive", as the gummy is.
I had my implant put in almost 6 years in Canada; I have a gummy. It was the standard implant being used in Canada at that time, and to my knowledge, remains so today. It's not the gummy that allows for one-step reconstruction; I had to have an expander and I had the implant put in during a second surgery. It's Alloderm that's key to enabling one-step reconstruction. The use of Alloderm in breast reconstruction is relatively new; it was not widely used at the time of my surgery and even now there are many PSs who don't use it. So I'm guessing that the PS that your wife will be seeing uses Alloderm. That's why one-step reconstruction may be possible for her.
As a couple of other people have mentioned, your wife should be aware that even if she has one-step reconstruction, revision surgery may be required, either within a few months or within the next few years. I'm going by memory here but last time I read through all the fine print that comes with the implants (both of the major implant companies post the information on-line), it indicated that around 35% - 40% of women require revision surgery during the first 3 years. And yes, as sweatyspice mentioned, implants do not last forever. No one knows for sure how long the gummies will last, and of course it's different for every woman, but the implants do need to be monitored and it's fair to assume that at some point in the future they will probably need to be replaced. It's kind of like the gift that keeps on giving!
-
Given Beesie's post above, I think it's important to understand that it's not only implant reconstruction which is likely to require revision surgery. Flap surgeries do, as well.
Depending on whether your wife is able to keep her nipple, there may be an additional procedure to create a new one. Of course, there are several options for how to do that.
Bottom line, no matter what you do, it all takes a while and putting up with a lot of inconvenience.
Agree w what Beesie has said about gummies, clinical trials, the FDA and alloderm.
There's a book titled something like "the breast reconstruction handbook" which is a bit outdated but a pretty good resource. I have it around somewhere, anyone know the correct title/author info? I'll look around, not sure where I put it.
-
First of all, Blair, your wife is a very lucky woman to have you supporting her and helping with all the research. It's daunting and there are so many questions! I'd also recommend Dr. Susan Love's book. It was a real help in explaining basics in a language I could understand.
As for the MRI, I couldn't agree more with you that it will provide more information to help you and your wife make a very difficult decision. I had one prior to my first lumpectomy, but unfortunately in my case none of the DCIS showed. I wish it had because I would have gone with the BMX with TE at the very beginning, rather than going through 2 lumpectomies and SND first.
The biggest reason we decided to go with the BMX, even knowing that implants will likely have to be changed out after 10 years and knowing that the entire process is long and painful, was the long term future. Being 43 and watching others I know go through the anxiety of wondering if it's returned after every follow up screening was something that I just didn't (and still don't) think I'm strong enough to handle for the rest of my life. It's hard enough to face it the first time. After getting the final path, turns out it was the right call. They had found yet another 2-3 cm area that hadn't shown on any mammos or MRI's.
It's so critical to do as much research as you can, but don't forget the long term emotional impact as well. There obviously aren't any guarantees, but you're doing the right thing to ask all the questions before making your decision. It's different for all of us and only you and your wife know what's best for you.
I'll be sending good thoughts your way and please let your wife know that if she ever wants support, she can send a note.
-
It is Saturday morning - 9/17/2011. Thank you for all your posts. They are extremely useful. I convinced my wife to look at my computer screen so she can see what the bulletin board looks like. I still think it will take a long time until she would ever use it and post on it herself. My wife read carefully two posts from Beesie - one on MRIs and one on gummy implants. I explained to my wife that Beesie is revered and has become a technical expert on breast cancer for the bulletin board. I actually like the sound of the gummy implant but again it is my wife's decision. The Breast Cancer Treatment Handbook had pictures of woman post-masectomy and pre-reconstruction. Since my wife does not have any excess body fat - only implant and Latissimus Dorsi flap reconstruction surgeries are options. The other flap options do not appear to be options for my wife. Unfortunately I must go back to China on Monday for 10 days coming back 9/30. My wife has gained in spirits and confidence. The plan for next week is the following - consultation with second reconstruction surgeon and discussion of the gummy implant as an option compared to silicone/saline implants and latissimus dorsi flap, MRI of both breasts (we are both convinced that an MRI is necessary and will provide additional useful information) and maybe meeting with oncologist (or this can wait until I come home). I hope my wife's sister-in-law who is a nurse can go with her to the appointments. Our hope is that the surgery will be in mid-October. Please keep the posts coming. Thank you once again.
-
BlairK: I chose bilateral masectomy for same reasons mentioned in other posts. Like your wife, I did not have enough body fat for any of the flap procedures. But I was a candidate for one-step reconstruction because my skin was in good shape (never having smoked is a big plus) and I did not want to go bigger. (I was a 34B originally). I had one 7 hour surgery, 2 nights in hospital, no complications, and my reconstruction already looked really good just 9 days out from surgery. I was amazed and grateful. I am now 4 months post-op and have not had to have any further surgeries / procedures. No revisions, nothing. I do not have nipples, so may get some tattooed on at a later date, there is no hurry for that, it's more of an aesthetic thing. Just wanted you to know it is possible to have MX / recon literally done in one step.
This is a very personal decision, and I am not trying to downplay the fact that masectomy is major surgery and there are risks and not everyone is as lucky as I was, to have everything go so well. Recovering from this was rough, as my pectoral muscles did not have a chance to stretch gradually like would happen with expanders, so I had a lot of chest pain the first 6 weeks after surgery. There is a thread on this website called "one-step reconstruction with alloderm" (or something like that) which you may want to check out...it would give you a lot more details from different women who chose that option.
Good luck to you and your wife!
-
Hi Blair, joining back in from the other thread.
As a recap for you, I was told I had to have a mastectomy due to my DCIS being multicentric and having small breasts (lumpectomy would be too disfiguring). After much research, I opted for a bilateral mast. I know myself well, and I know that I would obsess and worry about a new cancer developing on the other side. There were many things I looked into, statistics, and such, but what it came down to was I needed peace of mind. This is a very personal decision.
Regarding reconstruction, I am similar to your wife in that I have limited body fat (especially in the stomach) for a flap type procedure. The options presented to me were lat dorsi flap with implant or igap (flap from inferior buttock). I did much reading and was very fearful of implants based upon the % of women who have complications/contractures (my PS told me 30 to 50% have complications). I have suffered from chronic pain in the past and was not about to take a risk of signing up for that. So then I looked into IGAP's and was not very pleased with the complications related to that.
That left me with no feasible reconstruction option (regarding the risks). That was until I read the thread about microfat grafting. This is a pretty new procedure that is very promising and is much less invasive than the other options. However, there are few doctors doing it, it is a relatively new procedure, and it requires multiple surgeries and MUCH committment on the part of the patient. So, it is not for everyone, but I decided it was for me. Again, it's a very personal decision, but it is the one I decided upon eventually. Good luck to you in researching reconstruction options. I found that to be the most difficult area to research and make decisions about.
-
P.S. Plastic surgeons will often only present options they are skilled at. Just an FYI to do your due diligence, which I know you will do.
-
I am now back in Beijing. My wife went to a second reconstruction surgeon and likes him. She also went to a BC support group meeting which I am very happy about. The BC surgeon will do a MRI on her good (unaffected) breast but was adamant about not doing a MRI on her cancer-affected breast. Since we like the BC surgeon otherwise, my wife feels it is not worth making a big issue over this and I am not back home now to make a big issue over this. It would be interesting to hear any comments about when I doctor because of their opinion won't do something such as an additional test.
-
It really is pretty funny that he refuses to do the MRI, but if there's going to be a mastectomy it probably doesn't make a lot of difference.
I guess there's a cost difference between a two-breast MRI and a single-breast MRI, but the logic of the cost difference eludes me. They've got you in the machine, they're putting the contrast in your vein, and they're reading the MRI. What's the difference between imaging one versus imaging two?
-
Not trying to stir the pot here, but when I read "my wife feels it is not worth making a big issue over this" I had to hold back yelling at my computer screen. As cycle-path so eloquently wrote, the contrast, the machine time, the staff time, etc is all the same whether its one breast or two -- What is the true reason why this dr is against your wife getting a complete picture of what's going on in her "bad" breast? Is it because she wants her to get a mastectomy and fears she may instead choose a lumpectomy if the MRI doesn't suggest the need?
OMG, this is your wife's life, she must be her own advocate and not fear acting improperly or hurting anyone's feelings.
-
Dear cycle-path and CTMOM1234 - I was quite disappointed when I spoke to my wife over the phone (I am back in China) about the MRI. But sometimes a doctor's ego and biases can get in the way. From everything I have read and especially Beesie's post on the subject, I think an MRI of both breasts makes sense to me. My wife seems to have made her mind up to have a mastectomy with immediate reconstruction. She wants to only go through one major surgery and her fear with a lumpectomy is that she may need more than one lumpectomy plus radiation. My wife realizes she could need radiation with a mastectomy but the quoted chances are low - ten percent. Another factor is that my wife and there is no other way to say this is small-breasted (34B) and the DCIS involves 25 to 35 percent of the breast. We do not have any other options in terms of a BC surgeon. This is the best BC surgeon in our area and has a very good reputation. The BC surgeon operates a comprehensive breast health center. We can have access to our long-time internist. Any other option will involve travel of 90 minutes to a major city (New York or Philadelphia). My wife went to a BC support group so I am hoping maybe she gained something from that two-hour meeting and that maybe the subject of MRIs was brought up. As far as pressing the BC surgeon for an MRI of both breasts, that unfortunately will have to be up to my wife. I hope and pray that I will never need to say "I told you so" to the BC surgeon and say that she should have had the MRI of both breasts. I hope that if my wife has a mastectomy it will have clear surgical margins.
-
Blair, I'm a little confused. First there were concerns that your wife was not involved in learning about and making decisions regarding her care. Now that she appears comfortable with her decisions i.e. Surgeon, mastectomy, no MRI in one breast, you are questioning if that is the wisest choice. Although you have been offered wonderful advice by many on these boards, you have probably seen that due to individual variations in disease, differences in a doctors approach, and each woman's preferences, there are many ways to treat similar types of bc. Also, with only the deepest respect to the women who post here, few, if any of us are doctors, although many have done their research well. Your wife sounds as if she is rising to the occasion and becoming her own advocate. Maybe not doing what you would do, nor what I would do, nor what anyone else on these boards would do. You will all get through this. Caryn
Categories
- All Categories
- 679 Advocacy and Fund-Raising
- 289 Advocacy
- 68 I've Donated to Breastcancer.org in honor of....
- Test
- 322 Walks, Runs and Fundraising Events for Breastcancer.org
- 5.6K Community Connections
- 282 Middle Age 40-60(ish) Years Old With Breast Cancer
- 53 Australians and New Zealanders Affected by Breast Cancer
- 208 Black Women or Men With Breast Cancer
- 684 Canadians Affected by Breast Cancer
- 1.5K Caring for Someone with Breast cancer
- 455 Caring for Someone with Stage IV or Mets
- 260 High Risk of Recurrence or Second Breast Cancer
- 22 International, Non-English Speakers With Breast Cancer
- 16 Latinas/Hispanics With Breast Cancer
- 189 LGBTQA+ With Breast Cancer
- 152 May Their Memory Live On
- 85 Member Matchup & Virtual Support Meetups
- 375 Members by Location
- 291 Older Than 60 Years Old With Breast Cancer
- 177 Singles With Breast Cancer
- 869 Young With Breast Cancer
- 50.4K Connecting With Others Who Have a Similar Diagnosis
- 204 Breast Cancer with Another Diagnosis or Comorbidity
- 4K DCIS (Ductal Carcinoma In Situ)
- 79 DCIS plus HER2-positive Microinvasion
- 529 Genetic Testing
- 2.2K HER2+ (Positive) Breast Cancer
- 1.5K IBC (Inflammatory Breast Cancer)
- 3.4K IDC (Invasive Ductal Carcinoma)
- 1.5K ILC (Invasive Lobular Carcinoma)
- 999 Just Diagnosed With a Recurrence or Metastasis
- 652 LCIS (Lobular Carcinoma In Situ)
- 193 Less Common Types of Breast Cancer
- 252 Male Breast Cancer
- 86 Mixed Type Breast Cancer
- 3.1K Not Diagnosed With a Recurrence or Metastases but Concerned
- 189 Palliative Therapy/Hospice Care
- 488 Second or Third Breast Cancer
- 1.2K Stage I Breast Cancer
- 313 Stage II Breast Cancer
- 3.8K Stage III Breast Cancer
- 2.5K Triple-Negative Breast Cancer
- 13.1K Day-to-Day Matters
- 132 All things COVID-19 or coronavirus
- 87 BCO Free-Cycle: Give or Trade Items Related to Breast Cancer
- 5.9K Clinical Trials, Research News, Podcasts, and Study Results
- 86 Coping with Holidays, Special Days and Anniversaries
- 828 Employment, Insurance, and Other Financial Issues
- 101 Family and Family Planning Matters
- Family Issues for Those Who Have Breast Cancer
- 26 Furry friends
- 1.8K Humor and Games
- 1.6K Mental Health: Because Cancer Doesn't Just Affect Your Breasts
- 706 Recipe Swap for Healthy Living
- 704 Recommend Your Resources
- 171 Sex & Relationship Matters
- 9 The Political Corner
- 874 Working on Your Fitness
- 4.5K Moving On & Finding Inspiration After Breast Cancer
- 394 Bonded by Breast Cancer
- 3.1K Life After Breast Cancer
- 806 Prayers and Spiritual Support
- 285 Who or What Inspires You?
- 28.7K Not Diagnosed But Concerned
- 1K Benign Breast Conditions
- 2.3K High Risk for Breast Cancer
- 18K Not Diagnosed But Worried
- 7.4K Waiting for Test Results
- 603 Site News and Announcements
- 560 Comments, Suggestions, Feature Requests
- 39 Mod Announcements, Breastcancer.org News, Blog Entries, Podcasts
- 4 Survey, Interview and Participant Requests: Need your Help!
- 61.9K Tests, Treatments & Side Effects
- 586 Alternative Medicine
- 255 Bone Health and Bone Loss
- 11.4K Breast Reconstruction
- 7.9K Chemotherapy - Before, During, and After
- 2.7K Complementary and Holistic Medicine and Treatment
- 775 Diagnosed and Waiting for Test Results
- 7.8K Hormonal Therapy - Before, During, and After
- 50 Immunotherapy - Before, During, and After
- 7.4K Just Diagnosed
- 1.4K Living Without Reconstruction After a Mastectomy
- 5.2K Lymphedema
- 3.6K Managing Side Effects of Breast Cancer and Its Treatment
- 591 Pain
- 3.9K Radiation Therapy - Before, During, and After
- 8.4K Surgery - Before, During, and After
- 109 Welcome to Breastcancer.org
- 98 Acknowledging and honoring our Community
- 11 Info & Resources for New Patients & Members From the Team