I finally met with the surgeon, more options than expected

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CarolinaAmy
CarolinaAmy Member Posts: 281
edited August 2015 in Just Diagnosed

After a 2.5 week wait, I finally got to meet with the surgeon yesterday. I was surprised that he presented mastectomy or bilateral mastectomy as a comparable option; I expected resistance to that idea. Because I'm triple-negative, he agreed with my desire to go aggressive in treatment and not hold back. This tends to be an aggressive cancer and has a higher recurrence rate, which is then a very poor prognosis. I want to kick its tail NOW.

He's going to have me speak with the medical oncologist first, who may or may not be willing to do neoadjuvant chemo because my tumor size is right on the border for that plan. She may be unwilling because she'd be uncertain exactly how much to give me without the final pathology report on the tumor and lymph nodes. However, in my initial research, I'm interested in it because I want to make sure the chemo regimen works and there's some evidence that getting a 'pathologically complete response' to the chemo before removing it has a slightly higher success rate long-term.

I meet with the geneticist tomorrow and get an MRI Friday. If I come back positive for the BRCA mutations, or if anything else shows up in either breast, I'm going for a BMX. Otherwise, I'm still considering it... which brings up about a thousand additional decisions on which type and when--all complicated by other issues we have going on in the family right now. Apparently, I could do a TRAM flap or DIEP but there isn't enough down there to get me more than barely a B cup. (Talk about a shock--I would've thought there'd be more, LOL.) Currently I'm a 34F/G and not sure I want to go THAT much smaller.

Is there a good discussion somewhere about deciding between lumpectomy and mastectomy, and UMX vs. BMX?

It's so much to take in... I feel like I'm drinking from a fire hose.

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited August 2015

    carolinaamy - you also have the option of having a sentinel node biopsy (SNB) done prior to starting neoadjuvent chemo, which I would recommend. Neoadjuvent chemo always muddies the waters in regards to staging - it makes it difficult to know precisely how large your tumor is, and what your nodal status is, because you are relying on imaging for this information. By the time you have surgery the situation has changed - hopefully eradicating the cancer - so you are never really sure about what the initial picture was. I have a TN friend who had a SNB done when her port was installed prior to neoadjuvent chemo. She was assured of her nodal status before starting which was a big relief for her.

    As to your other question about discussion of surgery types, here is a very thoughtful and informative post by Beesie that discusses the pros and cons of lumpectomy versus mastectomy.

    Look at Ruthbru's post from Aug 8, 2015 for the full text.

    https://community.breastcancer.org/forum/5/topic/834036?page=1

    Edited by Mods to fix link.

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  • Moderators
    Moderators Member Posts: 25,912
    edited August 2015

    Thanks, SpecialK! That's the exact advice we were about to give. You're such a wonderful help!

    CarolinaAmy, please keep us posted on what you decide.

    --The Mods

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  • SpecialK
    SpecialK Member Posts: 16,486
    edited August 2015

    Mods - thanks, and thanks for the link help!

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  • solfeo
    solfeo Member Posts: 838
    edited August 2015

    Drinking from a fire hose. Yes it does certainly feel like that. I'm too new to have anything constructive to add, but just wanted wish you the best whatever you choose.

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  • CarolinaAmy
    CarolinaAmy Member Posts: 281
    edited August 2015

    SpecialK, I'm definitely wanting to get the SNB and know the lymph node status right now. The surgeon didn't mention that when we discussed neoadjuvant chemo, just that chemo would likely "make the nodes clear", but I'd push pretty hard for that. It's important to me to know the exact stage from the outset. If I do neoadjuvant, it'll give me time to find out node status which might impact whether I choose lumpectomy vs. mastectomy.

    I met with the geneticist yesterday and the gene testing is on its way. MRI is tomorrow morning.

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