Pre-pec implants and safety from a local recurrence standpoint?

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nash
nash Member Posts: 2,600
edited April 2018 in Breast Reconstruction

I'm on my third bc diagnosis. I've already had a primary on the L, followed by a local recurrence despite chemo/rads/extended course of Tamoxifen. That recurrence and previous radiation resulted in a mx/LD flap reconstruction with sub-pec implant. I hate my reconstruction, as I have been in extreme discomfort from off-the charts tightness 24/7 for the past 3 years. Front, side, back are all tight like I'm being crushed in a vice, but it's unclear how much the sub-pec placement of the implant contributes to the tightness.

I now have a new primary on the R. It's 8 cm, close to the chest wall, with lymph node involvement. I'm on neoaduvant chemo, then will have mx/radiation. I'm planning immediate reconstruction with TEs during radiation. But now the question is, do I do a sub-pec or pre-pec implant? I'm not doing another flap.

I have pleomorphic ILC, which has a high local recurrence rate and is very hard to see on anything but MRI. None of the PSs I have talked to have taken my subtype into account, or the proximity of the tumor to the chest wall into account in discussing the implant placement. I have started reading publications that suggest pre-pec implant placement on top of the chest wall can mask a local recurrence there, that they might not be the best choice for ILC patients, and that MRIs would still be needed every 2-3 years.

I will be discussing this issue with my radiation onc and med onc, but I wanted to find out if anyone's PSs have discussed the oncological safety of pre-pec implants with them based on their tumor size and location, and possibly even bc tumor subtype?

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  • farmerlucy
    farmerlucy Member Posts: 3,985
    edited April 2018

    Nash - I have no info about this, but I just wanted to tell you how insidious this crap is. I can't believe you recurred on the right. I'm so sorry. I think you are very wise to take into account your subtype. What a valuable lesson you are giving these doctor about the decision tree for recon taking into account each person's individual diagnosis.

    I've asked myself if I would have made the prepectoral decision if it had been available. That a tough one.

    Hang in there. Gentle hug.

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  • nash
    nash Member Posts: 2,600
    edited April 2018

    Thanks, FarmerLucy. Yes, this crap is incredibly insidious, and over the 11 years I've been dealing with my bc (and another five years on top of that with my late Stage IV bc mom's situation), I am constantly floored at how little the drs tell us and how much we have to advocate for ourselves.

    I'm on my fourth oncologist--I won't tolerate lack of attention to detail from them. My second onc would have killed me twice now if I'd stayed with her, as she wanted to discontinue my annual breast MRIs a few years after my first diagnosis, despite the fact that I had extensive pleomorphic LCIS left over in the L breast post-lumpectomy, which needed to be monitored for life. She would have missed the local recurrence on the L and the new primary on the R, after blithely telling me I could rely on my mammograms. Those same mammos, including 3D, have now missed three tumors. My third onc and and the original surgeon missed the 8 cm new primary on the R prior to doing a mastopexy on that side when I had my L side LD flap revision in 2016 because they wouldn't do an MRI prior to that surgery, stating it would be hard to read due to crossover inflammation from the LD flap on the L. You'd think they'd have done more thorough manual exams on the R in that case, but no. And this was at a major NCI Cancer Center/teaching hospital in a major metro area.

    So, yeah, I'm a little paranoid! Hugs back!

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  • farmerlucy
    farmerlucy Member Posts: 3,985
    edited April 2018

    aaaargh!! Thank goodness you advocated for yourself! Aaargh!

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  • KBeee
    KBeee Member Posts: 5,109
    edited April 2018

    I do not have experience with ILC. I do have experience with recurrence though. Mine was between the pec muscle and the skin, and my MO made the comment that it was a good things my implant was under the pec, or I would have never felt it. As much as it's annoying sometimes, I do like being able to feel anything that's there. If you have them on top of the pec, I would just push hard for yearly MRIs.

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  • nash
    nash Member Posts: 2,600
    edited April 2018

    Thanks Kbeee. That confirms my suspicion. I’m sorry you had a local recurrence. My local recurrence and new primary were both caught on mri. I wonder if I’d have problems getting mri approved going forward after this second mx. It’s definitely something I’ll be asking the drs about

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  • calidancer
    calidancer Member Posts: 88
    edited April 2018

    I don't know if this would apply to ILC, but my breast surgeon said that there is more likelihood of a recurrence on the skin side or in the scar. I had a close margin chest wall side but because she took the fascia off the muscle that acts as a very clean demarcation or barrier. So there is a much lower chance of breast tissue being left behind for a recurrence to grow in- as can happen when they try to divide the tissue on the skin side. For me that was somewhat reassuring.

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  • nash
    nash Member Posts: 2,600
    edited April 2018

    Thank you, calidancer. I’ll ask my BS about the fascia etc.

    My local recurrence was in the scar tissue from the lumpectomy. I’m so paranoid about growing local tumor #4 somehow.

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