the reduction+lumpectomy thread

Poppy: Thank you. I hadn't realized, before breast surgery #2, that I'd end up looking as peculiar as I did after it, or I'd have been adamant about talking to a PS beforehand! (though in fairness, the BS might not have realized either, until he looked at the site after I'd been anesthetized.. Always start charitably.) But I will insist on seeing one before the rads at least, though needing a mastectomy would be a game changer, obviously. Should I insist on having the reconstruction/reduction done before rads? How badly are the surgeons going to squawk about waiting until after radiation because that'll affect how my breasts look? Been through a few months of medical squawking, nay the headless chicken dance of CANCER!DOOM!, last year (it wasn't) and I'm not sure how much more I can take..

Movingsoccermom: I'm not looking forward to swimming restrictions during/after radiation; my ankles are STILL unsteady 10 months after (spine) fusion/decompression. Gentle walking is about all i CAN do, even on level pavement. But my sympathies about the tennis problem! I'm left-handed, and my breast surgery...was on the left. No node involvement, yet. And goodie, I get to try to offer something back--have you tried One Hanes Place? (Maybe you have. Maybe it's some other thread's dead horse du jour.) Not every bra in creation, but what they have, they carry in a wider array of colors and sizes than any store I've seen.

The web site's http://www.hanes.com/onehanesplace.

I think if you can get a really good comfortable and supportive one for a decent price then it would probably be worth it.

I have been reading through these threads for a few days and found them extremely helpful. I am scheduled for a lumpectomy reduction on Oct. 6th. I was told that the surgery would take me down by about two sizes, which I am fine with. I am still struggling on whether or not I want to match the other size at the same time or wait until after radiation. My PS said in that case, he would use a PA to suture while he starts on the other side, but I don't know how comfortable I am with a PA suturing my breast. Any other area, I wouldn't care. Also, because PS said I had thinner skin which is more prone to scabbing. Is common for a PA to suture on breasts during plastic surgery? Thank you.

As Poppy noted, I had a BS and PS. They didn't work at the same time but from my understanding the removing of the cancer by the BS didn't take much time, then the PS went to work. There was never really a mention of doing separate reduction surgeries and I did talk to the PS about the radiation possibly changing the size of one. His thought process was that he's rarely had that happen to the point of being an issue and if for some reason we needed to, we could wait until until after radiation and everything has settled properly and if I felt the need, we could then reduce the good side to match the radiated side. Just a thought.

I have completed my surgery, segmental mastectomy with tissue rearrangement. The surgery went well, and I didn't have much pain the first few days. Now, I am having pain in the upper right area where the tissue was removed and replaced with other tissue. It is a light burning feeling, but not hot burning. Like a sore burn. Not noticeable all the time, but especially when touched. Also get pain anytime I walk into a cold room, or there is a cold breeze! Is this a normal kind of pain for tissue rearrangement surgery? How long does this last?

I think after the first 24 hours, you should be able to walk them. Good luck!

I am a 38I (with the unaffected left breast originally a bit larger than the cancerous right one). NEVER was the subject of reduction or symmetry brought up. My cancer center has several oncoplastic surgeons but they were not brought in--I saw only my breast cancer surgeon pre-op. The first and only time the subject of my breast size came up was when at 2-1/2 weeks post-op my SNB incision (steri-stripped, not sutured) ruptured the day after I was told to remove the strips and my seroma literally erupted all over my clothes and the bathroom. When I went to the breast center (on an emergency basis), the bs' nurse told me I would just have to “let it heal from the inside out" and spend weeks if not months changing gauze dressings several times a day. I told her that was not an option. My own surgeon was in the O.R. at the time, but her partner was available. He took one look and said “that's going to need to be sutured; the weight of your very large breast won't let it close on its own and is probably what pulled it open." He squooshed out about another half cup of fluid before suturing it. The sutures stayed in for two weeks before being successfully removed. One month after that, so far so good.

When I asked the bs' nurse as she was dressing the sutured incision about whether I ought to get reductions, she told me they recommend against it (unless the breasts are so large they're causing upper back pain or attracting unwelcome attention and emotional problems) because of the danger of “fat necrosis, additional seromas, and calcifications." My bs the week after that told me that a double reduction and mastipexy entails extensive scarring and a painful recovery--as painful and arduous as a BMX with immediate reconstruction (albeit without an additional incision and drains from a flap site). At 64 (and married 44+ yrs), if I'm not going to put myself through face-lifts, fillers, liposuction, gastric bypass or even Botox, I'm certainly not going to do anything that drastic for my looks. (Heck, I’m even putting off cataract surgery). Perhaps if I were younger and unattached it would be a different story. But considering that I chose lumpectomy + radiation in part to avoid a more extensive surgery and possible complications....

Meanwhile, radiation caused my previously imperceptible tumor-cavity seroma to enlarge to the point where my right breast is fuller and wider than the left; but since the left hangs down further they both fill out my bra cups evenly. I don't particularly care how symmetrical I look naked (nor does my husband), so as long as I look the same way in a bra, swimsuit and clothed as I did before, I see no need to put myself in further danger and pain for the sake of visual perfection.

No judgment or offense meant to those who chose a different path.

Hi all,

I'm not sure yet what type of surgery I'll be having. I'm coming up on my 5th round of chemo next week and I'm scheduled to talk to my oncological surgeon and meet the plastic/reconstructive surgeon on January 12. Back when I initially met with the oncological surgeon, just before starting chemo, she suggested that, depending on my response to the chemo, we might be able to do a lumpectomy. My primary tumor was not that large, and it has shrunk by more than half so far with the chemo.

She did also ask if I have ever considered breast reduction. I'm a DD cup and it had always been in the back of my mind that I might do a reduction at some point in my life. I'm fine with the idea of it. I've never actually loved having big breasts, and in all honesty, I'm kind of excited by the prospect of having smaller breasts.

I did have a couple of questions about it, for those who have been through a combination of lumpectomy and reduction. First, was it all done in one surgical procedure, or did you do them separately? How long was the recovery from the surgery (or surgeries)? How long does it take for the scars to fade?

Also, how did you decide how much of a reduction you wanted? Or was that decision based on how much breast was removed in the lumpectomy?

MDW: I ended up having the lumpectomy and reduction as two separate surgeries; if I'd been thinking straight, I'd have asked about having a reduction at the time of the second lumpectomy. That said, it's not the end of the world that I had them five months apart, since one of the things my PS did was scar revision on my left--I still had a livid streak across my breast.

I'm not quite three weeks out from the reduction and revision, so not entirely sure what I"ll end up looking like. But certainly my left's better than it was beforehand. PS took a tuck in the left, so I'm shaped a bit more normally.

Wow, thank you all--momoshcki, queenmomcat and justmaximom--for your responses! It's really helpful to know that it might be possible to do the surgeries in one shot, if I can get the surgeons' schedules to align. It would really be my preference to not have to do two separate surgeries, unless there's a strong reason to. I'm missing a fair amount of work for chemo right now--I'm taking about one of every three weeks off. If I could focus on recovery from a single surgery, that would be preferable because I'm burning through my short-term disability benefit.

Also, I'm heartened to hear that recovery might not take as long as I was originally assuming. I know it's not a minor surgery, but I wasn't sure how long before I might be able to be back on my feet and able to do some activities, and get back to work--at least working from home.

I had my breast reduction and lift to both of my breasts at the time of my double lumpectomy surgery.  The size of the reduction was never discussed with me. The PS did what he needed to do. I went from a very large D cup to a small D cup/very large C cup.  I needed to have the reduction/lift because I had a double lumpectomy and approximately 12 cm of tissue had to be removed.  The two lumps were not next to each other.  The surgery was necessary so that I would not have been deformed from the double lumpectomy surgery.  I was told that if I did not have the reduction/lift that my breasts would not be the same size and the nipples would not be even.  The surgery was medically necessary.

My PS and BS worked in tandem and I had both breasts done at the same time.  My PS made the bc breast slightly larger because he knew that I would be having radiation. Radiation has a tendency to shrink a breast.  Now that I am post radiation, my breasts look wonderful.  They are even.  The radiation faded the scars to my bc breast so that breast looks absolutely phenomenal.  Radiation works much better than Mederma for making scars vanish!  The scars to my non bc breast are more visible but they look fine.  I notice the scars but I don't think that the scars would be visible to anyone else.

I healed from the surgery immediately.  I felt fine right away.  No problems at all.  The only issue for me was that I had to sleep on my back which is difficult for me because I am a stomach/side sleeper.  I did not need pain meds but I took them anyway for a few days just in case.  However, now, my bc breast is still numb (1 year and 5 months later).  I attribute that to the SLNB surgery because my other breast was fine immediately.  I do have complete sensation in both of my nipples, however.  Yay!

It was a great decision for me to have the double lumpectomy to my left breast with the double breast reduction/breast lift.

Unfortunately, my insurance company stated that the surgery to my right breast was cosmetic and they refused to pay for the right breast surgery.  Of course, it is a law that medically necessary surgery must be done.  However, I had to fight my insurance company at the same time that I was fighting bc.  It was awful.  What an unnecessary nuisance.  In the end, the insurance company paid the bill after an extremely long battle.

Good luck.

Dear ChiSandy:

No one ever discussed scar tissue, fat necrosis, fibrosis, sclerosis, or any other side effects of this type with me regarding this surgery.  Interesting.

I must confess that when it comes to surgery, I am a world-class wuss. Been through two laparoscopic knee surgeries, two total knee replacements, trigger-thumb tendon release, an open-reduction/internal-fixation tibial plateau and fibular repair, cholecystectomy, C-section.....and that's just as an adult. Watching DH have to go through first an emergency hemicolectomy and then an emergency herniorrhaphy within a month, I was exceedingly relieved to need only a lumpectomy and SNLB. Perhaps, in retrospect, I should have called in a plastic surgeon before my lumpectomy to discuss the possibility of taking “Thelma & Louise" down to a more manageable size, but who'd expected my operated-on breast would actually enlarge after surgery & radiation?

3D CRT is a partial-breast external radiation protocol in which CT scans in 3 dimensions are used to plot the exact location of the tumor cavity and a relatively small area of surrounding tissue. The cavity and margins are given high-dose radiation for 16 treatments, as opposed to the 33-treatment protocol of 28 lower-dose to the whole breast + 5 “boosts” to the tumor cavity. It minimizes side effects and damage to the rest of the breast. In my case, I never got the usual fatigue; and by the time skin changes were supposed to start appearing, my treatments were over. I did get some pinkness and tanning, plus hardening and swelling of the tumor-cavity seroma. Radiation usually causes shrinkage of the treated breast, but mine actually enlarged. Pre-diagnosis, it was the smaller of the two (if you could call an H or I cup “small”), but now--though it’s fuller and sits higher than the more pendulous left one--both breasts have approximately identical volumes. It may actually be a bit bigger than the untreated one--I notice that when I first don my bra or shelf-cami, my cleavage skews slightly to the left.

I have found this thread helpful for me personally but no one has posted for a long, long time. I hope someone is still out there...

I was diagnosed with BC Nov 20th, 2017. I am a triple negative so I have to undergo the "full meal deal." I started with Chemo first because my tumor was 4.7cm and it was believed that I would have a better surgical outcome if the tumor shrunk. I did Chemo from December to end of March with AC and Taxol. May 2, I had a right-side lumpectomy, and because I was a DD size cup they could take generous amounts to get the margins. The breast was reconstructed & reduced so I would not have to have large amounts of radiation, and the left breast was reduced for symmetry. I am very happy with the results.

I started Radiation on June 2, 2017 and am presently am having some wound healing issues to the rad side. I am told the wound will heal after rad but my biggest complaint is the discomfort of the bra. I am now 7 weeks out from surgery and this bra that I am wearing hits the incisions which are still tender and my plastic surgeon says to just find one that is "more comfortable". The plastic surgeon did a very nice job but he is not good at explaining aftercare and the printed material I was given after surgery from the hospital did not include much detail on care after 6 weeks. I have been using the internet for aftercare info and even that does not address my concerns: How long do I have weight restrictions? How long do I wear the bra day and night? When can I resume sleeping on my side? What kind of bra am I suppose to be wearing? If anyone is still monitoring this thread, I would sure like to know what their doc ordered for a bra.

Hello, I had a lumpectomy with reduction on the right and a year later had a reduction on the left so that I would match. 4 years later, I have yet to find a comfortable bra. I am now trying to wear undershirts instead. Bras just dig in in a bad place.

You should heal pretty quickly after your surgery - and as far as weight restrictions or how much you should be wearing a bra, or what side to sleep on, just go by what feels comfortable. If it hurts, don't do it.

good luck in your healing!