the reduction+lumpectomy thread

Newbie, my situation is somewhat different: had a lumpectomy in March of 2011 for what turned out be be ADH. Two months later had a bilateral reduction and went from a 34D to a 34B. Recovery wasn't bad at all. I was allowed to change from the surgical bra to a sports bra after a couple of days. Once the incisions healed, I could ditch the sports bra for a non-underwire bra. If I recall, ithink the surgeon told me the underwire was ok after 6 weeks. Likewise, after 6 weeks I was cleared for vigorous exercise. I don't remember any restrictions about sleeping on my side and I think I resumed that as soon as it was comfortable. Six + years out I have no problems and scars are nearly invisible. PS advised me to generally wear a bra but said there was no harm in occasionally going braless, say, under a sundress.

Newbiegirl- I was diagnosed in January, 2016. I had an lumpectomy, brachytherapy radiation and chemo. I finished all of that last June. A lumpectomy/reduction wasn't offered at the time (I was a generous DD). Who knows if I would opted for that or not if it was offered. I did ask my BS about a reduction at my 6 month check, she told me that I had to wait a year after radiation. Fast forward a year, and I had a bilateral lift/reduction last week. Pain and movement-wise, so far, so good. Cosmetically, looks ok in clothes. Out of clothes, well, still in the Frankenboob stage.

I do know that radiation will slow healing a bit, so probably more patience than you may be interested in exerting is likely in order. Otherwise, Flavirose is right. Listen to your body with respect to lifting, wearing a bra 24 hours a day, etc. You will know when it is ok. Or, more likely, you will just do something (like roll over on your side when you are asleep) and realize that it was ok.

I think the bra fitting is an excellent idea. Those women are great!

Hi Newbiegirl

I had a lumpectomy-reduction on May 24.

My scars are still covered in adhesive strips, which are changed once every 7-10 days.

On surgeon's advice, I wear a soft sports bra which opens at the front. I have been told to wear it 24/7 - to prevent the scars from stretching while healing. I was told time and gravity will cause sag - wearing a bra doesn't prevent that.

I am seeing the PS 7 weeks after surgery. He will then decide if I have to continue with strips and 24/7 bra.

I start radiation - 15 fractions over 3 weeks as per Canadian/UK/AU/NZ practice - on 10.07. I am terrified.

I asked about shrinkage of breast but RO and technologists just looked puzzled and said it was unlikely.

I have been advised that hormone therapy is not recommended as side affects outweigh my survival benefits as per the Predict program.

Hi, lllmae - this is my first post here! I wanted to respond because I had my lumpectomy+reduction just a few days before yours and remember feeling the same way. Especially the first couple of days when I was told NOT to remove the surgical bra and left to wonder just what was going on in there.

I am starting to get used to the smaller size - and now that the post-surgical swelling is going down (including my swollen belly), I am just now starting to feel better and more confident about my decision. Hope you are feeling better every day, too.

Update on “Thelma & Louise" (aka “the girls").

My first post-rads mammogram showed my tumor-cavity seroma was 14cm. Six months later it shrank to 10cm. By then, “Louise" (the operated R breast) was back to her original size vis-a-vis long droopy “Thelma," and was about a cup size smaller. A couple of months thereafter, I went back to Rigby & Peller for a re-fitting, and found that I was down to a 40G in Prima Donna (or 38H with a back extender), Elomi or Curvy Couture and 40F in Empreinte. But 2 weeks ago at my latest mammo, my seroma is less than 6cm. Because of some fibrosis remaining, “Louise" doesn't look deflated, but she also doesn't look like she's got a softball-size tobbaco “chaw" along her outside. She looks absolutely normal: nipple pointing straight ahead, perky, round, albeit still larger than normal. In fact, but for the faint incision scars you would have thought she's the “normal" one. But she's more than a cup size smaller than “Thelma" (who looks like a basset hound's ear with nipple pointing at the floor); and my cleavage now skews to the right. Naked, the girls now look more like Mutt & Jeff (if you're old enough to remember that comic strip).

Slept in a leisure bra with a Swell Spot tucked inside, for a bit less than a year, which helped soften the fibrosis and shrink the seroma. As for underwires, my incision wasn't along the curve of the wires so I was allowed back in them as soon as I found them comfortable…while still in radiation, in fact.

I have requested a PS referral for possible reduction on the left. Maybe bilateral. Why now? Because I am experiencing upper back pain, only partially the result of a deep muscle strain suffered while working out. (X-rays say no spine or rib fractures or lesions). I have also developed “wedging" between T7-8, and the resulting kyphosis is aggravated by the girls pulling me forward & down—hard to stand up as straight as my PCP and trainer would like me to. My BS' (new, thank goodness) NP says it might be too long after lumpectomy for symmetry to be considered coverable by Medicare, but the back issues might make reduction coverable, provided it's bilateral.

As to other surgeries, I chickened out of a trigger-thumb (AI-caused) release on the morning of surgery because the shot kicked in and the thumb stopped triggering; though I'm getting intermittent index-finger triggering it doesn't hurt nor does it impair my guitar-picking. But when LensCrafters couldn't visualize my retinas nor further correct my Rx for reading because my cataracts were too ripe for the optometrist to see through, I bit the bullet and had my cataracts replaced in fall 2016. (Wish I'd done it earlier).

Oh—and I am back to an annual mammogram schedule (just like pre-bc), though still semiannual for both BS and Prolia shots.

My PS went for symmetry and I did get some shrinkage during radiation so the treated breast is a bit smaller than its companion. Interestingly, the radiation really helped the dog ear. The untreated side looks like I have a small pointy extra breast on my back. I started with F /G breasts, but that was the size after a 100 pound weight loss so tons of saggy skin for the PS to try to address. I'm sorry that your swelling didn't recede.

Lyn

Hi, Dizzybee - I'd never say you were crazy. If you hated the way you looked and could fix it? Go for it. Good luck and congratulations.

I am still in the midst of neoadj. chemo and not slated for surgery for at least 2 months. I'm starting to really think about my surgery options and am happy I found this thread. The more I think about surgery the more anxious I get. I have a week until I meet with my surgeon for a chemo-progress-consult and my head is spinning with all the questions I have for her. Maybe you guys can help me.

Here's some info on my situation: I am large breasted and overweight. Depending on the bra I am 38G-40H (even before I gained all my weight I was 32F.) My tumor is in my right breast on the lower outer quadrant and close to the chest wall. It was 7cm before chemo and now that I'm half done it is palpable at maybe 2cm.

If it is on option for me I would like to do a lumpectomy on my right breast and EVENTUALLY get reduction/evening-out surgery after I'm healed. One reason is that I live alone and need to get back to work ASAP - two reasons for getting the least surgery possible so recovery is short and not that debilitating. On a side note, I am terrified of dog ear look under my arm.

What questions should I be sure to ask the surgeon given my dream scenario? I have a long list but I'm sure I'm missing things.

THANK YOU!

Thank you, Dizzybee. I appreciate your taking the time to write. I will find out a lot more in 6 days when I see the surgeon. It's good to know what's possible going in to the consult.

Thanks, Lyn. I appreciate your sharing.

I just wish Friday would get here so I can have my follow-up surgery consult already! My tumor hasn't totally disappeared after 4 AC treatments but it is much smaller. I really hope I can get a lumpectomy.

Good news! I met with my breast surgeon today and she said she can't see any reason I can't have a lumpectomy + reduction. I am so relieved. After my 4 A/C infusions my tumor shrank from 8 cm x 6 cm x 3 cm down to 2 cm x 1 cm x 1.5 cm (measurements from surgeon and oncologist physical exam - won't get an MRI until I 'm done with Taxol.) There my be a little infiltration into the pectoral muscles still, but won't know for sure until I have the MRI. However, surgeon said that even if there was still a bit of muscle effected, she'd still be able to do lumpectomy.

After she gets the results on the margins I'll go in for part two, reduction on both sides by a plastic surgeon. I haven't met him yet but his bio lists his research interest is the relationship between radiation and reconstruction. That seems to be someone I'd like.

I am soooo relieved that I probably am going to be able to keep my breast, including the nipple - even if smaller version. Before my diagnosis I never once considered reduction, but now it makes sense.

Thank you all who have added your stories to this thread. You all have helped me so much.

Thanks, illimae! I'm a G/H. Although I never considered a reduction I think I'd still feel like myself as a D/C.

My surgeon would prefer I have a 2-step procedure. Because I have possible pectoral muscle involvement and my original tumor was so large, she wants to have the pathology on margins back before I proceed with the reduction - like a week to 10 days later.

My oncological breast surgeon works closely with the plastic surgeon even though he won't be in the OR. The plastic surgeon will mark up my breast before the lumpectomy procedure so any lumpectomy incisions will be within or along his lines.

I'm very happy that this is an option - I can't tell you guys how much better I feel today than this time yesterday.

Hi, Dizzybee - Thanks!

I will know more when I meet with the plastic surgeon and oncol surgeon again. I'm assuming if we don't get clear margins with the lumpectomy that the margin shave can be done on the same day as the reduction - not separate surgeries.

One thing has been replaying in my mind since my onc surgeon consult on Friday. The surgeon almost closed the conversation by saying that she'd guarantee cosmetically pleasing results if I did the lumpectomy alone without the reduction. Just that off-hand comment planted a seed of doubt as to whether or not lump+reduc is the right thing for me. Ugh! The decision is really a lot for me.

Also, I've looked more into the plastic surgeon that was recommended. Just last month he published a study on the effects of radiation on reconstructed breasts. After following the conversation on that topic in this thread I was reassured he'd be very conscious of how radiation would effect the ultimate look of that breast.

Thanks again everyone for sharing - I'm learning so much from you!

I was told I had to wait four weeks after the first op before I could have the margin shave, they said it needed to heal first before they would go in again. I didn't ask why. But I don't think the pathology results are available here till a few days later anyway.

I didnt get big margins, mine were clear but close, so they wanted to get a bigger margin. But my reduction was a consequence of the amount of tissue they were removing, and now the reduction surgery to my good breast to finally match up. I'm still waiting for the swelling to go down to see how close they are, I've been wearing a silicon gel partial prosthetic for the last eleven months and can't wait to get rid of it! But even after two lots of reduction surgery the good breast is significantly bigger, I just need the swelling to go down to see how well this has worked.

Hiya, Dagny - Thanks for writing. I really hope the surgeons are able to save your nipple.

Did your BS discuss brachytherapy with you for the radiation?

Thanks again for sharing your story. I PM'ed you a couple questions, too.

Hi Autum...sounds like we're on a very similar timetable. My surgery is in two steps, so lx 12/28 and then reduction and reconstruction (if they can't save my nipple) on 1/9. So I'll be interested to hear how things go for you on the 4th. I'll be doing radiation afterwards too....so we can compare notes on that also.

Agatha, I'm going to see my RO on Tuesday and I want to talk with her about partial breast radiation. But, the bs said I was not a good candidate for brachytherapy because my cancer is so close to the surface, right under my nipple. She thought it would likely burn me and make it even less likely that the poor nipple could survive (and I've got to admit, i'm fairly attached to her!). But I plan to talk with her about all possible options....doing radiation 3 hours away from home is going to be really difficult and isolating.