Just diagnosed IDC multifocal

Hi Reflect:

That is what may be called a compound question. Is the Tuesday meeting with a plastic surgeon?

Time-frame for recovery seems to vary from person to person (e.g., by age, overall health, complications, co-morbid conditions) and by the nature and scope of surgery. Recoveries with reconstruction, particularly with procedures that rely on autologous donor tissue from another site, may tend to be longer. Once you have a better idea what types of procedures you are eligible for and would consider, you may be able to get more specific advice.

You can ask the breast surgeon about that recommended time-frame for surgery based on the pathology findings, including the results of the node-biopsy.

If indicated, the sequence of treatments may vary. Radiation can often be avoided with mastectomy. However, in some cases, the surgical pathology findings, including node status, may lead to the recommendation of radiation even with a mastectomy.

The pathology results, including the histological type (e.g., ductal), (estimated) size of the tumor(s), node status, estrogen receptor (ER), progesterone receptor (PR), and HER2 status, are some key factors considered in choosing systemic therapies pre- or post-surgery. However, other information may be considered in the decision-making process (e.g., age).

In some cases, endocrine therapy, chemotherapy, and/or targeted therapy (e.g., HER2-targeted therapy such as trastuzumab (HERCEPTIN), pertuzumab (PERJETA)) are given prior to surgery ("neoadjuvant" treatment). Because of this, some patients with IDC, especially those with triple-negative (ER- PR- HER2-) or HER2-positive disease (any ER, PR and HER2+), consult with a medical oncologist ("MO") prior to surgery.

The size of the tumor can factor into the decision about neoadjuvant treatment. Neoadjuvant treatment may allow for an assessment of response to drug therapy (e.g., during treatment, at surgical pathology). Sometimes, neoadjuvant treatment is used to shrink a larger tumor to permit the option of lumpectomy plus radiation.

Otherwise, decisions about "adjuvant" (post-surgical) endocrine therapy, chemotherapy, and/or targeted therapy are made in consultation with a medical oncologist after surgery, when the pathology of the surgically removed tissue and lymph nodes are available. In appropriate cases, additional tests, such as the Oncotype DX test for invasive disease or the MammaPrint test may be performed, and the results are used to inform decision-making about chemotherapy.

Be sure to obtain copies of all written imaging reports (which may contain information about extent of disease, whether it is close to the nipple, etc.) and copies of all pathology reports, including all related addenda, supplements or appendices (e.g., ER, PR and HER2 test results). You should understand how your treatment plan relates to your specific pathology results.

I felt even better after meeting with the surgeon and getting an idea about the treatment plan.

BarredOwl

Hi reflect:

Reconstruction warrants a significant amount of research. The following is not a complete list of matters to be researched.

I didn't have reconstruction, but I did consult with a plastic surgeon to find out what procedures I qualified for and to discuss what each procedure entailed, likely aesthetic results in my specific case, the risks and complications of those procedures, including the possibility of subsequent procedures/adjustments. I also asked how each procedure and its success or timing might be impacted or complicated by possible further treatments (e.g., radiation; and chemotherapy as it can make one more susceptible to infection). Consulting with a plastic surgeon can help to streamline your research if you do not qualify for certain procedures or if you find you would not consider certain types of interventions (e.g., which impact a second site for example). Some consult with more than one plastic surgeon.

It is very important to ask how many breast reconstruction procedures the plastic surgeon performs each year, and for a procedure of interest to you, what percent of the total procedures performed were that specific procedure.

For the more common complications (e.g., capsular contracture) or complications of particular concern (e.g., infection, flap failure, tissue necrosis in nipple-sparing procedures), be sure to ask what is the overall complication rate determined from clinical studies, what is the hospital's complication rate, and what is their personal complication rate, if known. Inquire if your presentation raises concern for any specific complications.

Introductory materials from ACS: http://www.cancer.org/acs/groups/cid/documents/web...

Do not hesitate to ask for photographic examples of their work, and confirm that they were the lead plastic surgeon in the procedure shown, and if the results shown are typical for most patients or represent an optimal outcome. Lighting should be strong and suitable for seeing scarring and contour. Before and after images should have essentially identical sharpness and lighting conditions. For procedures with a donor site, the photo should clearly show the donor site impact (unobscured by undergarments), or if not within the image, a second photograph should clearly illustrate donor site impact.

If you are open to non-reconstruction, this site, created by Erica from these boards, is an excellent resource:

www.breastfree.org

That corner of the state is a beautiful area. I am in the metro Boston area. I took pictures yesterday, because the snow coated the branches and twigs and it was beautiful (although we had a good deal of tree damage).

BarredOwl

Hi reflect:

I am very sorry to hear about the nodes. Be sure to request a copy of the full pathology report for those findings, and ask if the nodes were marked (enabling specific removal later) and how these pathology findings will be factored into the recommendation regarding the initial type of lymph node surgery.

This page from the National Cancer Institute also has some helpful information comparing breast-sparing (breast-conserving) surgery (lumpectomy), with mastectomy alone, and mastectomy plus reconstruction. (If lumpectomy is an option for you, very likely lumpectomy plus whole-breast irradiation would be recommended.)

http://www.cancer.gov/types/breast/surgery-choices

My surgeon advised that I should not drive until the "drains" were removed, which depends on how fast fluid output decreases. My drains were removed relatively quickly (6 days) (which is probably less common). However, due to unexpected arm issues, I waited more time before driving. Certain medications may also lead to restrictions on driving.

It is around 20 degrees F and snowing, and they are predicting about a foot of accumulation.

BarredOwl

Hi Reflect,

Reconstruction with implants is easier and quicker to recover from than other types of recon that use your own tissue. When you discuss recon options with plastic surgeon(s) you might want to ask them what they would do in case you need radiation.

Congrats on the good news yesterday, hope it goes well today.

Hi reflect:

It is good to have a plan. It looks like they have suggested further work-up and then neoadjuvant chemotherapy (prior to BMX) for hormone receptor-positive, HER2-negative disease? I have no experience with chemotherapy, neoadjuvant or otherwise, and assume they explained to you what the advantages of that approach are for you, as compared with surgery first, then chemo.

At one time you were considering a second opinion at Dana Farber, and if you are still interested in that, it should be sought prior to initiating neoadjuvant therapy. If still interested, you may wish to contact Dana Farber now to get into the queue and inquire with them about the best timing for such consultation relative to the further biopsy and work-up so as to avoid any delay, [EDIT: particularly if the opinion turned out to be confirmatory].

I wish you all the best as you move forward with your plan.

[EDIT: And I forgot to wish you clean scans! Will keep you in my thoughts.]

BarredOwl

Hi reflect:

I am delighted to hear your scans turned up nothing new.

If they were to find invasive cancer on the left, it could conceivably have different features (ER / PR /HER2 status, which might have implications for treatment plan), but I am hoping for clearly benign results for you.

It is minus 1 F here now, and expected to drop to minus 11 tonight, with windchill as low as minus 29. Even colder where you are I think. Stay warm!

Hope you have Monday off, and a little time to recharge.

BarredOwl

Hi Reflect, if you plan working during chemo consider having infusions at the end of the work week. For example, I had AC infusions that take a long time to administer, on Thursdays. Took a sick day for that and worked from home on Friday after infusion, that gave me enough time to recover over he weekend. For me the third day, i.e. Saturday was the worst. Weekly taxol was faster to administer and somewhat easier to handle. I had it on Fridays.

You can handle it, good luck!

it might depend on the chemo, but in my case - AC - the third day, i.e. Saturday was the worst. I was told the steroids wearing off by day 3 are the culprit.

Hello from a fellow New Englander with similar stats! Sorry to hear you are going thru this now, reflect. Wanted to chime in on the Thursday chemo. That's what I did, chemo Thursday and no work Friday. Honestly, I usually felt quite good on Friday due to the steroids. The rest of the weekend was bad, but really, I mostly slept thru it. Monday was not great, but I was able to work. I'm not sure what tx you are doing but Taxol wasn't that bad. Best wishes, keep us posted.

Pam, I've been following your thread but didn't really know what to say because we're in the same boat. I'm having a difficult time emotionally, as well. I was on prozac for hot flashes but stopped taking it because I'd heard it might not be good for breast cancer. I finally got in to see the MO and he said it's absolutely OK to take and put me back on it. It helps the hot flashes immensely and now that I'm back on it I feel a lot better emotionally. I still think about the cancer all the time but the sadness and anxiety aren't so overwhelming. I'm sorry you don't have more family around but it's great that you have so many friends. I also have had a very difficult time learning to accept help from others and it's gradually getting more comfortable. I've done a lot for other and I know that what goes around comes around and I'll have the opportunity in the future to help those who are helping me. I'm hopefully having my BMX with tissue expander placement on 2/25 but my calcium level is high and now they're doing a whole body scan to make sure I don't have mets. If I do, the surgery will be delayed until after chemo.

Thanks for the link to caringbridge. It does make people feel good when they can help. I keep telling my sister "remember everything you're doing for me and that I'm letting you do it, so next time I offer to do something for you, you'll let me do it!" She's awful about not letting people do stuff for her, too.