HELP - Struggling with the aftermath of an ineffective MX

In early 2014, I had a uni MX after an initial diagnosis of extensive, strongly hormonally positive DCIS of around 6cm. I was recommended to have a skin sparing MX and offered the opportunity of a DIEP reconstruction, which I did. It was very much promoted as a cure by the surgeon. My post-op follow-up meeting was good; I was informed all had gone well and as well as extensive DCIS and some LCIS (some PLCIS) I had just one small micro-invasion. I had no further follow-up with the breast surgeon and met with the oncology team to discuss tamoxifen. However due to a history of fibroids and endo and the already good prognosis I decided not to take tamoxifen at that time. The hospital very much supported that decision.

Fast forward 6 months from my MX and just as I finished my reconstruction pathway; I found a small nodule then in the following month, more of these in my reconstruction. I had two further "lumpectomies" on my reconstructed breast with a more specialist unit and it appears I had around 4cm of remaining, likely residual, DCIS and again some PLCIS just under the skin. I'm very thankful (lucky) that again, I only had one small invasion of lobular BC.

Of course, after all this I am far better informed about the risks of some residual breast tissue remaining but I now feel terrified about what I am actually left with in terms of active breast tissue. The histopathology reports after my first 'lumpectomy' on my reconstruction state that there were breast ducts and lobules visible in the excised tissue; I thought any tissue remaining would be just scrapings not my entire breast structure! The team that completed the mastectomy will not comment except to say that the plane in my breast was difficult to follow and that I had some superficial breast tissue (none of this was shared with me post-operatively before my discovery of further disease but only after - which makes me so cross). It has also emerged, in trying to unravel, what went wrong that at the time of my surgery the original hospital did not check any anterior margins after a MX.

I have had to make decisions about whether or not to take radiotherapy and the short and long term risks of it without really knowing how much residual tissue is left. Of course usually, radiotherapy is reserved for node-positive/and more advanced disease and I feel worried that the fact my new team have suggested it means I have alot of residual potentially active breast tissue. Whilst, after alot of thought, I passed on radiotherapy I am having six-monthly imaging with my new team and annual mammograms

I have been told by my team that it is impossible to tell from either an MRI or a mammo exactly how much tissue remains after a DIEP. Has anyone else encountered this? I thought that MRI was an incredibly sensitive tool and would easily spot the difference between residual breast and the new DIEP 'tummy' tissue.

To cut a long, emotional, so disappointed story short I suppose I am desperately trying to find ways to feel more comfortable with what is left of my reconstructed breast; that is on top of making peace with the fact that I had such a long operation and as you know not-easy recovery to be in this situation which even after a year still keeps me awake some night.

Any helpful thoughts/experiences, hugely appreciated.

Thanks everyone,

PS I am 44 year old mum of 4... pre-menopausal. I must complete my bio :)

Comments

  • KBeee
    KBeee Member Posts: 5,109
    edited February 2016

    Wow. You've been through a lot. If you go here http://www.hopkinsbreastcenter.org/services/ask_expert/ and go to the category on breast imaging, maybe they can answer your question in regards to imaging. I would definitely get a few opinions on how best to proceed.


    I had a recurrence after mastectomy too, but even though IDC was present, there was not any breast tissue present, so it was a different situation; a couple stray cells got loose and grew in my case.

  • Nolton9
    Nolton9 Member Posts: 25
    edited February 2016

    Thanks for the link KBeee. I will pose the imaging questions to them.

    I see from your biog that you've had an extended treatment path too.. Not sure if you found your recurrence yourself or it was detected by mammo etc but either way it's just such a shock so quickly after such a big surgery. I am still so angry with the hospital that did my Mx; not so much that they had a problem completing the surgery but that I wasn't informed of the problem so that I could make better informed decisions as to whether I should have further surgery at the time or even radiotherapy.

    Thanks for replying.


  • KBeee
    KBeee Member Posts: 5,109
    edited March 2016

    That's horrible that they did not tell you. I would be beyond angry. It's unethical! I would research some good breast surgeons and plastic surgeons for consults...even if you have to travel a ways to do so. You are worth it, so be sure you get the best opinions moving forward to clean up the mess left behind from the first team.

  • dtad
    dtad Member Posts: 2,323
    edited March 2016

    Nolton9 IMO you should get a second opinion at a university based teaching hospital. You should NOT tolerate subpar treatment. Good luck and keep us posted....

  • Nolton9
    Nolton9 Member Posts: 25
    edited March 2016

    Hi,

    Thanks for your comments.

    Agree dtatd re subpar care. I'm in the UK and had my first-line surgery, MX and DIEP at a specialist cancer hospital who have a world-wide reputation. Looking back; I was overly reassured by that and whilst I didn't question the suitability of the surgeon they provided I certainly did question him re a number of areas relating to his plans ; which essentially they either didn't answer or I was too stressed/ or not quite well informed enough about at that time to know that they mattered.

    I think you have far tighter guidelines in the US re certain aspects of cancer treatment, such as margin testing; here there is no strict national guidance on that area, like there is for women who have breast conserving surgery. So in my case the hospital, essentially checked the wrong margins; deep and nipple and omitted to check my anterior margin; which as I had just DCIS which was actually palpable before DX was probably a huge, fat clue it was the anterior margin which needed checking. There was also a note after the surgery re some issues in clearing superficial breast tissue.... A perfect storm for me; not them.

    I am at a new specialist breast clinic now and in a closer surveillance program for a few years; including alternating MRIs; so I know that is alot more than is usually available after reconstructive surgery and I am fortunate. Very mixed feelings though about how something that is supposed to have 'gone' can cause so much hassle!

    thanks!



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