bi-lateral mastectomy or radiation

Hi Shocker,

It's a tough decision to make, we are all so different even though we share the same disease.

Your Oncologist is your 'cancer doc' and I'd listen to him over your surgeon.  You have a strong family history and you are relatively 'young' in BC world.  I asked for a BMX when I received my first dx at 42, then when I was dx again at 46.  Someone finally listened when I was dx for the third time and I had BMX/DIEP.  I had three different primaries, all IDC & DCIS. I guess my opinion is biased as I wouldn't have had to go through #2 & #3 dx if I'd had a BMX the first time.  I also wouldn't have had tissue damage from rads, or have developed thyroid problems from rads 'scatter' on my left side.

My attitude from my first dx was "take them, I don't feel any emotional attachment to body parts that are trying to kill me".  But that's my perspective and you will research and ruminate on your situation until you reach your own conclusions.  Decide what is right for you and you alone, and go with it.

All the best,

She

Among the medical/risk things be sure to consider  how you personally handle stress.  Are you a person who is likely to be living a life in fear if you do not get the mastectomy now?  Or are you they type of person who will be able to move on and only stress a little every time you get your annual or semi-annual screening?

shocker,

Usually a surgeon or oncologist will present the choice of a 'lumpectomy with radiation' or a'mastectomy'.  I don't understand why you've been given the choice between a 'lumpectomy w/radiation' and a 'bilateral mastectomy'. To deal with your current diagnosis, a BMX is absolutely unnecessary - DCIS doesn't travel from one breast to the other, and in fact it's extremely rare even for invasive cancer to move from one breast to the other.  So for an oncologist to suggest that you remove both breasts when you have cancer in one is more than a little strange.

Where a BMX comes into consideration is if you are very high risk to be diagnosed again and/or if you are fearful of another diagnosis and would gain peace of mind by having a BMX.  Many women choose to have bilateral mastectomies for that reason, but the decision to remove the 'healthy' breast is separate and very different from the decision on what to do with the breast that has breast cancer.  And the decision to remove the 'healthy' breast is not a medical decision - there is no medical reason to remove a healthy breast; it's a personal choice on how to deal with future risk.  That's a valid discussion for your oncologist to have with you, but again, it seems very odd that your oncologist has not also presented the option of a single mastectomy.  With a single MX, you can always decide to remove the other breast at a later date if you then feel that it would be better for you.  

I had too much DCIS in a small breast so I had no choice but to have a mastectomy.  After having a clear MRI and a negative biopsy on my other breast (my 4th negative biopsy on that breast, so it certainly has a history of being 'busy'), I made the decision to have a single mastectomy. That was over 6 years ago and I remain happy with that decision.  I am glad that I still have one natural breast, with natural movement and feelings. And other than a few benign cysts, I've so far had no problems with my remaining breast.  I know that I have about a 20% risk of developing BC in this breast, but I prefer to think that there is an 80% chance that I won'd develop BC. But if I do, I will still be glad that I kept my healthy breast for these extra years.

A single MX might not be the right choice for you, but I would think that it is another reasonable option in your situation and as such, you may want to include it in your considerations.  That might muddy the waters, or it might make the decision easier.   

Shocker - If you haven't already talk to a geneticist about your risk, you might consider that. For me the thought of semi annual screenings, more biopsies, the financial issues associated with that, not to mention the stress, and that is if nothing more comes up, was all too much for me to deal with. Best of luck with your decision. You've come to the right place.

If I were you, I'd get the BMX.  BS are very reluctant to do BMX unless there is cancer in both breasts.  I had a cancer in my right breast and was going to do a Uni, but then opted for a BMX.  I don't have any regrets, despite the loss of nipple sensation, which is a bummer.  However,  it reduced my risk of recurrence and that is what I wanted.  You have a pretty significant history, so the chances of  recurrence seem pretty high to me.  If it came back, you would probably do a BMX, but if you have already had radiation, then your reconstruction will be more difficult.  As it stands now, you will probably have an excellent cosmetic result because you don't need radiation.  

Best of luck on your decision - I know it's a tough one!

My bc on the left side was in a duct however when I pointed out the lump two years prior they decided it was a cyst and didnt check it.  They did check it when I had a very small spot on the right side and it was cancer.  It was located on scar tissue from a biospy in 1993 which turned out to be benign.  The cyst was large but not all cancer and they offered me to have the lump removed on both sides which I did.  I have had LE on both sides along with cellutitus x2 on the small side.  Kinda wondered why the right side deals more problems than the larger one that did have 4 nodes.  Going to ask my dr when I see him.  I had good margins and low grade on both sides.  While my mother died of bc (refused treatment) she was post menopausal and died at 71.  Have done everything my mother would not chemo, rads and tamoxifen so I really dont feel at this time I have a loaded gun pointed at me just the se's of treatment.  I fall into a gray area for staging either 2b or 3a because of the cyst not being totally cancer.  It is what it is. Just wondered why a small spot would cause more problems than a larger one.