decisions, decisions

armywife,

With DCIS, sometimes there can be microinvasion that's not discovered until after surgery when the pathology is done. By that time, it's too late to find the sentinel node and make sure nothing has spread. So, usually the surgeon will want to take a sentinel node at the time of the mastectomy. Otherwise, if invasive cancer were later found by the pathologist, then an entire axillary dissection might be recommended. Regarding taking only one node during the sentinel node biopsy, sometimes nodes are clumped so close together that it's not possible to take the sentinel node without taking one or two others. So, I doubt any good surgeon would sign a promise to take only one.

Edited to say: I just read laniek's post saying that she already knows she has some microinvasion, so of course it makes sense to have the sentinel node biopsy. 

curveball,

Especially when a person is slim, if she has a good breast surgeon who manages to remove virtually all the breast tissue, the result will be a chest with very prominent ribs and hardly any tissue in between ribs and skin. While it might be nice to have some "padding", leaving padding would probably be a bad idea as it might mean leaving breast tissue and thereby increasing the risk of recurrence. In heavier women, I believe there's more fatty tissue between the breast tissue and the skin, so it's possible to leave that fatty tissue. I'm slim myself and my chest is a bit bony, but it's also smooth and flat with symmetrical incisions that are almost invisible after six years. I have a lot of sensation back and I don't have unpleasant feelings. I'm sorry you've had that problem.

Hi curveball,

Apparently, those of us who are thin don't have much subcutaneous fat there. After my surgery, I asked my breast surgeon if the bony areas would fill in over time and she shook her head, sadly, and explained about taking every possible iota of breast tissue out, which left very little tissue behind.

I actually have had the same thought as you about fat grafting. If I weren't so averse to any further procedures, I might even consider it. Since micro fat grafting is still quite a new procedure, I would expect that in the next few years it might become even more feasible to use it to create padding. Dr. Khouri, one of the pioneers of the technique, also claims that it restores radiated skin and tissue.