Need to decide by Monday...help!

Being in a high risk category and everything you've already been through, I say just have the BMX.  

I did (and my breasts were my favorite part of my body as odd as that sounds.).    I miss them, but realize how necessary the surgery was.   

I wish you the best and understand your dilemma and frustration.

lulu, I have small, dense Breast. My surgery was almost 2 years ago, I no longer even notice the chunk that was removed. It is a non issue. Living with the fact of being stage 3, and the amount of Cancer in my axillary is frightening, but having a mastectomy, for me, would of made this more difficult.

Lulu,

So sorry you are faced with this decision at such a young age. It is indeed a very tough decision to make. In the end, I suggest to go with your gut so to speak. I thought maybe my story could help in some way. I totally get how frustrating it is to deal with calcifications! I had a small lump in my right breast in my early thirties, it was near the underwire area of my bra and caused pain. After much debate my doctors decided a simple lumpectomy was in order which I had done. 3 months after I started geting mammos every 6 months so they could watch the area and developing calcifications. I too had small (B cup) dense breasts and the mammos were very painful. After about three years of this I was cleared but the lumpectomy made my right breast noticeably smaller, small price to pay ok. Fast forward to age 45. I felt an area in my left breast that felt weird to me so I requested to have a mammo which identified an area of concern. They also at this point saw calcifications again in my right breast. I underwent biopsy on the left which revealed IDC. An MRI was ordered at this point which revealed four areas of concern on the right that were not picked up on mammo. Four biopsies later and four negative results I had enough. I was on the verge of cancer treatment on the left and then lots of monitoring on the right. I just could not go back to having so many mammos! I am petite and thin and the constant mammos and the pain and worry were too much for me to think about. I elected to have BMX in the end. My gut feeling told me that was the best option to finally get my life back without the constant monitoring with mammos.

Long story short, after final pathology came back on the right a small 7mm IDC was found. It turned out to be a grade one cancer and was slow growing, but would have had to been treated eventually. In other words, I would have undergone treatment for my left side and ended up starting over again a few years later when the mass on the right was finally discovered. It is a difficult decision. The surgery went well for me as did the recon and eventual switch to silicone implant. The expansion process, I cannot lie, was painful for me. The doc said because it was because I did not have enough fatty tissue in that area so the expanders rubbed against my ribs. But in the end the recon turned out very well and I am two years out now from treatment and doing well.

I hope this helps in some way. Good luck

Gully

hi lulu!

Not gonna tell you what to do, but I second the going with your gut idea.

I was a c cup, very dense breasted gal. Had the option of lumpectomy however, I chose bmx because I wished to avoid the neverending scrrenings, biopsies, expense and worries. I knew right away it was right for me. Also, my cancer never was seen on all those mammos, so what would they do, MRIs each time? And biopsies every time they see anything! Ugh. No thanks.

Yes it is a transition to live breast free at first. But you know what? You get used to it fast and it is sort of liberating. I am still undecided as to recon. But feeling great and moving on.

Whatever you decide, best wishes and hugs. It is not easy

Hi Lulu, I am copying over a post put together by beesie, on of the resident experts on the boards. It gives a good, non-partial list of things to consider as you make your decisions:

"Some time ago I put together a list of considerations for  someone who was making the surgical choice between a lumpectomy,  mastectomy and bilateral mastectomy.  I've posted this many times now  and have continued to refine it and add to it, thanks to great input  from many others.  Some women have gone through the list and decided to  have a lumpectomy, others have chosen a single mastectomy and others  have opted for a bilateral mastectomy. So the purpose is simply to help  women figure out what's right for them - both in the short term but more importantly, over the long term. 

Before getting to that list, here is some research that  compares long-term recurrence and survival results. I'm including this because sometimes women choose to have a MX because they believe that it's a more aggressive approach.  If that's a big part of someone's rationale for having an MX or BMX, it's important to look at the research to see if it's really true. What the research  has consistently shown is that long-term survival is the same regardless of the type of surgery one has. This is largely because it's not the  breast cancer in the breast that affects survival, but it's the breast  cancer that's left the breast that is the concern. The risk is that some BC might have moved beyond the breast prior to surgery. So the type of  surgery one has, whether it's a lumpectomy or a MX or a BMX, doesn't  affect survival rates.  Here are a few studies that compare the  different surgical approaches:

Lumpectomy May Have Better Survival Than Mastectomy

Twenty-Year Follow-up of a Randomized Trial Comparing Total Mastectomy, Lumpectomy, and Lumpectomy plus Irradiation for the Treatment of Invasive Breast  Cancer

Twenty-Year Follow-up of a Randomized Study Comparing Breast-Conserving Surgery with Radical Mastectomy for Early Breast Cancer

Now, on to my list of the considerations:

• Do you want to avoid radiation? If your  cancer isn't near the chest wall and if your nodes are clear, then it  may be possible to avoid radiation if you have a mastectomy. This is a  big selling point for many women who choose to have mastectomies. However you should be aware that there is no guarantee that radiation may not be necessary even if you have a mastectomy, if some cancer cells are found near the chest wall, or if the area of  invasive cancer is very large and/or if it turns out that you are node  positive (particularly several nodes).
• Do you want to avoid hormone therapy (Tamoxifen or an AI) or Herceptin or chemo? It is very important to understand that if it's believed necessary or  beneficial for you to have chemo or take hormone therapy, it won't make  any difference if you have a lumpectomy or a mastectomy or a bilateral  mastectomy.  (Note that the exception is women with DCIS or  possibly very early Stage I invasive cancer, who may be able to avoid  Tamoxifen by having a mastectomy or a BMX.)
• Does the length of the surgery and the length of the recovery period matter to you? For most women, a lumpectomy is a relatively easy surgery and recovery.  After a lumpectomy, radiation usually is given for 6 weeks. A mastectomy is a longer, more complex surgery and the recovery period is longer.
• How will you deal with the side effects from Rads? For most patients the side effects of rads are not as difficult as they expected, but most women do experience some side effects. You should be prepared for some temporary discomfort, fatigue and skin irritation,  particularly towards the end of your rads cycle. Most side effects go  away a few weeks after treatment ends but if you have other health  problems, particularly heart or lung problems, you may be at risk for  more serious side effects. This can be an important consideration and  should be discussed with your doctor.
• Do you plan to have reconstruction if you have a MX or BMX? If so, be aware that reconstruction, even "immediate" reconstruction, is  usually a long process - many months - and most often requires more than one surgery. Some women have little discomfort during the  reconstruction process but other women find the process to be very  difficult - there is no way to know until you are going through it.
• If you have a MX or BMX, how will you deal with possible complications with reconstruction? Some lucky women breeze through reconstruction but unfortunately, many have  complications. These may be short-term and/or fixable or they may be  long-term and difficult to fix. Common problems include ripples and  indentations and unevenness. You may have lingering side effects (muscle pain, spasms, itching, etc.) on one side or both (if you have a BMX).  If you don't end up with symmetry (symmetry is not a sure thing by any means, even if you have a bilateral mastectomy with reconstruction done on both sides at the same time), will you regret  the decision to remove your breasts or your healthy breast? Are you  prepared for the possibility of revision surgery?
• How you do feel about your body image and how will this be affected by a mastectomy or BMX? A reconstructed breast is not the same as a real breast. Some women love  their reconstructed breasts while some women hate them.  Most probably  fall in-between. Reconstructed breasts usually looks fine in clothing  but may not appear natural when naked. They may not feel natural or move naturally, particularly if you have implant reconstruction.  If you do  choose to have a MX or BMX, one option that will help you get a more  natural appearance is a nipple sparing mastectomy (NSM). Not all breast  surgeons are trained to do NSMs so your surgeon might not present this  option to you. Ask your surgeon about it if you are interested and if  he/she doesn't do nipple sparing mastectomies, it may be worth the  effort to find a surgeon who does do NSMs in order to see if this option is available for you (your area of cancer can't be right up near the  nipple).
• If you have a MX or BMX, how do you feel about losing the natural feeling in your breast(s) and your nipple(s)? Are your nipples important to you sexually? A MX or BMX will change your  body for the rest of your life and you have to be prepared for that.  Keep in mind as well that even if you have a nipple sparing mastectomy,  except in rare cases (and except with a new untested reconstruction  procedure) the most feeling that can be retained in your nipples is  about 20% - the nerves that affect 80% of nipple sensation are by  necessity cut during the surgery and cannot be reconnected. Any  breast/nipple feeling you regain will be surface feeling only (or  phantom sensations, which are actually quite common and feel very real); there will be no feeling inside your breast, instead your breast will  feel numb. For some, loss of breast/nipple sensation is a small price to pay; for others, it has a huge impact on their lives.
• If you have a MX or BMX, how will you deal emotionally with the loss of your breast(s)? Some women are glad that their breast(s) is gone because it was the source  of the cancer, but others become angry that cancer forced them to lose  their breast(s). How do you think you will feel? Don't just consider how you feel now, as you are facing the breast cancer diagnosis, but try to think about how you will feel in a year and in a few years, once this  diagnosis, and the fear, is well behind you.
• If you have a lumpectomy, how will you deal emotionally with your 6 month or annual mammos and/or MRIs? For the first year or two after diagnosis, most women get very stressed  when they have to go for their screenings. The good news is that usually this fear fades over time. However some women choose to have a BMX in  order to avoid the anxiety of these checks. 
• Will removal of your breast(s) help you move on from having had cancer or will it hamper your ability to move on? Will you feel that the cancer is gone because your breast(s) is gone? Or  will the loss of your breast(s) be a constant reminder that you had  breast cancer?
• Appearance issues aside, before making this decision you should find out what your doctors estimate your recurrence risk will be if you have a lumpectomy and radiation. Is this risk  level one that you can live with or one that scares you? Will you live  in constant fear or will you be comfortable that you've reduced your  risk sufficiently and not worry except when you have your 6 month or  annual screenings? If you'll always worry, then having a mastectomy  might be a better option; many women get peace of mind by having a  mastectomy.  But keep in mind that over time the fear will fade, and  that a MX or BMX does not mean that you no longer need checks - although the risk is low, you can still be diagnosed with BC or a recurrence  even after a MX or BMX. Be aware too that while a mastectomy may  significantly reduce your local (in the breast area) recurrence risk, it has no impact whatsoever on your risk of distant recurrence (i.e.  mets).
• Do you know your risk to get BC in your other (the non-cancer) breast? Is this a risk level that scares you? Or is this a risk level that you can live with? Keep in mind that breast cancer very rarely recurs in the  contralateral breast so your current diagnosis doesn't impact your other breast. However, anyone who's been diagnosed with BC one time is at higher risk to be diagnosed again with a new primary breast cancer  (i.e. a cancer unrelated to the original diagnosis) and this may be compounded if you have other risk factors. Find out your risk level  from your oncologist. When you talk to your oncologist, determine if  BRCA genetic testing might be appropriate for you based on your family  history of cancer and/or your age and/or your ethnicity (those of  Ashkenazi Jewish descent are at higher risk). Those who are BRCA  positive are very high risk to get BC and for many women, a positive  BRCA test result is a compelling reason to have a bilateral mastectomy.  On the other hand, for many women a negative BRCA test result helps with the decision to have a lumpectomy or single mastectomy rather than a  bilateral. Talk to your oncologist. Don't assume that you know what your risk is; you may be surprised to find that it's much higher than you  think, or much lower than you think (my risk was much less than I would  ever have thought).
• How will you feel if you have a lumpectomy or UMX and at some point in the future (maybe in 2 years or maybe in 30 years) you  get BC again, either a recurrence in the same breast or a new BC in  either breast? Will you regret your decision and wish that you'd had a bilateral mastectomy? Or will you be grateful for the extra time that you had with your breasts, knowing that you made the best  decision at the time with the information that you had?
• How will you feel if you have a bilateral mastectomy and no cancer or high risk conditions are found in the other breast? Will you question (either immediately or years in the future) why you made  the decision to have the bilateral? Or will you be satisfied that you  made the best decision with the information you had?

.I hope that this helps. And remember.... this is your decision. How  someone else feels about it and the experience that someone else had  might be very different than how you will feel about it and the  experience that you will have.  So try to figure out what's best for  you, or at least, the option that you think you can live with most  easily, given all the risks associated with all of the options.  Good  luck with your decision!"

((lulu)) if it helps, I had BMX no recon in 2010 so been flat for five years and it's all right. Not great of course, I miss my breasts, but I've adapted and so have all the people in my life including DH (dear husband).  Have you checked out breastfree.org?  It's a non-profit website founded by a BCO sister with lots of helpful info.  It helped me and may help you too.  Best wishes!

http://breastfree.org/

p.s. Ruth, great post from Beesie!

lulu. I Had double mastectomy January, no regrets, decided I did not want to worry about lumps bump etch. I was an f cup, so they are gone, no radiation, no burns etc. it truly is your decision, but once you make it, be at peace with it. You will still need to be checked by you gyn and oncologist , but it was not hard to part with them, and I don't think I am gonna reconstruct, a padded little bra will be plenty, you will never see anything. Pray on it and be at peace with whatever you decide.

Are you thinking of chemo? Because if that is in the cards, you really do want to get started sooner. I went to the research pages of BCO just now & this is what I found (it is talking about how soon to start chemo after surgery, but am thinking it would also apply to getting surgery done ASAP itself):

Doctors recommend starting treatment as soon as possible after breast cancer is diagnosed. Timely treatment reduces the risk that the cancer will spread and increases the chances for survival. Still, sometimes women delay treatment for a number of reasons, including cost and scheduling. But if treatment is delayed too long it can affect survival.

A new study has found that women who wait more than 60 days after surgery to start chemotherapy are more likely to have the cancer come back someplace in the body away from the breast (metastasize) and also are less likely to survive compared to women who start chemotherapy within 30 days of surgery.

The study was published online on Jan. 27, 2014 by the Journal of Clinical Oncology. Read the abstract of “Clinical Impact of Delaying Initiation of Adjuvant Chemotherapy in Patients With Breast Cancer.”

***question from me: have you talked to an oncologist yet? They might have a different take from a surgeon. I know my GP (who was my 'go to guy' all the way through) PUSHED me to get started fast....he didn't even like the two week delay between my diagnosis and surgery.