We are not happy.
So my breast surgeon and myself wanted to do surgery within 4 weeks of my last infusion but I decided it would be wise to schedule 5 weeks out from my currently scheduled last infusion because I have had problems with low platelets and there is a chance my last infusion will be delayed by a week like the previous two. If it isn't, I would have surgery 5 weeks after, which I am ok with. They want to do immediate reconstruction to minimize complications.
The plastic surgeon, however, said he schedules 6 to 8 weeks from the last infusion. Not thrilled but would do 6 max. I got a call from his scheduler bumping this to 10 weeks out!!!! I told her I was NOT ok with that! She finally said the soonest she could give me was just under 7 weeks out and tried to play this off as being in my best interest. I see this as dishonest and am not ok with that.
My cancer is grade three, poorly differentiated and aggressive and I have have increased vascularity in my bones that make them easy for micromets to get to. My platelets completely recover 4 weeks out from my last infusion and are in the middle of the normal range by this point. Maybe this cosmetic surgeon is a good one but I am not comfortable with the time frame and do not appreciate the scheduler trying to pass this off as being in my best interest when I know it is not. I am considering going with a different cosmetic surgeon who can do it sooner. The catch is, I will likely have to go with a new breast surgeon and will likely have to transfer centers if I do this. If I go with a different cosmetic surgeon within the same system it would have to be with a colleague of the first and I worry that will cause hostilities against me and I don't want someone who dislikes me doing surgery on me ( I had a bad experience when shopping around for MOs somewhat related to this). So I am inclined to just leave the system for the surgery even though I like the breast surgeon and don't really want to have to do this. My other option is not doing immediate reconstruction. I don't care about being flat for a while but they believe it will make reconstruction more difficult.
Opinions?
Comments
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hello I'm Tammy I was briefed reading your post, not that we have the same thing going on. I would like to speak with somebody who knows more than I. I've had a lumpectomy I've done chemo and radiation, we're talking about a double mastectomy. Just wanted someone to talk to let me have experience and the cancer breast cancer environment. If you're up and willing to talk? Call me 954 5489164?
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hello I'm Tammy I was briefed reading your post, not that we have the same thing going on. I would like to speak with somebody who knows more than I. I've had a lumpectomy I've done chemo and radiation, we're talking about a double mastectomy. Just wanted someone to talk to let me have experience and the cancer breast cancer environment. If you're up and willing to talk?
(Edited by Mods to delete member's personal phone number. We strongly recommend not posting personal information on a public forum, for your own privacy and security. Please exchange contact information using the Private Message feature.)
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Sorry Tammy, I don't have long distance calling and don't give my number out to people I can't meet in person due to the unfortunate abundance of scammers and phishers these days. I suggest you also refrain from giving your number out in online forums. If you wish to speak to others in your situation or a similar situation in person, there is likely a support group in your area. If you wish to speak to members here privately you can PM then.
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WC3 - It's so frustrating when we can't plan our treatment in the way we feel is best for us. My last experience was similar to yours, and I understand the desire to move quickly - but now on the other sIde of it, I also understand the reasoning behind what can feel like an unreasonable delay.
I had a local recurrence, TN, grade 3. Had chemo and rads the first time around, my MO and BS concurred I needed an MX this time (I reluctantly agreed). I asked to do chemo before surgery as I was caretaking my mother and needed to be mobile and available for her at that moment. That also gave me time to meet with a PS at a different facility (none local). I opted for DIEP; he told me their preference (major university hospital) was “a couple months" PFC because the immune system needs time to recover; surgery too quickly can lead to complications. Prior to my final chemo we met again to arrange everything; I asked for 6 weeks and he balked, he asked for at least 8 weeks. I argued I wanted any remnants of this aggressive second-time-around cancer out of me; he insisted 2 weeks wouldn't make a difference. We split the difference and scheduled at 7 weeks when he had an availability.
Surgery went off without a hitch, and recovery started out good. Drains came out at two weeks - and I ended up back in the hospital, twice, with an ABX-resistant superbug. I've never in my life seen a doctor blanche giving me a diagnosis; I thought it was good it wasn't MRSA, they had been hoping it would be “that easy". I spent 10 weeks recovering, returning to work far earlier than I felt ready but needed to.
Now, of course, I look back and would have done things differently, but since I can't I share this not as a scare tactic but as an experience. My PS and MO have both said my case wasn't usual or typical, but highlights why they like to wait a little while post-chemo. Everybody recovers and heals differently, and the body needs time.
It's hard to be patient, I know, but theres a fine balance between getting rid of whatever might still be lurking, and being as healthy as possible. Knowing what I know now, I would opt to wait a little while for surgery, especially if you like this surgeon. Whatever you decide,I hope your surgery is timely and complication-free.
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NancyHB:
I'm on Neulasta so my neutrophils and WBCs are the only things that have stayed up during chemo. The main concern would be my platelets but they come back up by week 4 after my chemo infusion. I was actually in the hospital before starting treatment, with a tube in my chest due to lung issues and it was very easy to see how someone can get an infection. It was very difficult to keep the tubes off the floor when I had to use the restroom and sometimes the tubes that had touched the floor would touch the bed sheets and I had to ask for my sheets to be changed a few times to avoid the contaminated bed sheets from making contact with my incisions. It seemed like I could do a much better job of keeping things clean at home but I was plugged in to a suction device in the wall. But I'm sure a lot of infections start in the OR.
By week 4 after my infusion I am starting to feel back to normal. I'm anemic but my platelets arw fine and I can do a slow 2.5 mile walk. By 5 weeks I think I would be back to normal but so would the cancer cells.
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Give the center called NOLA a Call. They can do implants but they are alsobwizards at natural tissue recon. No hard feelings at home between surgeons. Traveling was not a big deal for it (they help with all that too). Most women travel to them from all over the world literally. www.breastcenter.com
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Lula43:
I'm aware of that center but my insurance only covers my state as far as I am aware.
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you can call Nola and ask. They will know/find out.
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Lula73:
I am waiting for them to call me back but I do know they are out of network with my provider at best.
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wc3- I didn’t have chemo, but I did have to put off recon because the ps was scheduling 3 months out and I needed the cancer out NOW. It was far more important to me to get the cancer out ASAP, I could do recon later. It worked out well for me because I ended up needing rads. I am scheduled for TE surgery in a few weeks.
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Also try Dr Craig Blum at Sweetgrass PS in Charleston & Dr Marga Massey also in Charleston. They both used to be at Nola and do fabulous work.
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I was told that 4-6 weeks after chemo is ideal for most cases. If it's important to you to stay close to that time frame and you like your BS - perhaps ask them if there's another PS they can suggest that might be able to do the surgery sooner.
Of course - there are always cases of delays for one reason or another. If a delay is needed for health reasons then that's one thing. For a busy surgeon's schedule ... IDK. You need to be comfortable with the plan.
Also - it's completely possible that the scheduler doesn't understand your situation for timing. And that the PS is not even involved with that process! You may want to alert them directly to see if they can work something out that's better.
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I spoke to the scheduler today and she told me that this is a busy season for surgeries for some reason, and the BS wanted 4 to 6 weeks past my final infusion and the PS wanted 6 to 8 weeks or possibly longer in to December, and the compromise was 7 weeks. If my final chemo gets delayed due to low platelets, as the previous two have, that will make the time between by final infusion and surgery 6 weeks, which is within the time frame the BS wants. There is some evidence that around 6 weeks might be best for those doing neoadjuvant chemotherapy and I am fairly anemic even at 4 weeks out from an infusion and my healing has been slow so maybe I do need more than 4 weeks to recover from the chemo. I also spoke to my chemo nurse and she thought it was better to do 6 to 7 weeks than schedule 4 weeks out and have to cancel it due to low platelet problems and risk not getting another date quickly. I'll run it by my MO at my follow up.
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NotVeryBrave:
I tried to find out if the issue was particular to this PS as he does a lot of other types of procedures as well or if it is a department wide thing but didn't really get a direct answer...I'm not sure if she has direct access to the other PSs schedules. I do know I don't have enough tissue at the moment for what we wanted to do so maybe that is one reason he wanted to push out farther but I would rather get the cancer out sooner and do reconstruction later if that is the case.
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plastic surgeons are busy in Q4 - people have leftover money that they are willing to spend prior to yearend. That and vacation time used for recovery. And many of our surgeries require significant blocks of OR time. Coordinating two or more surgeons plus the OR takes a bit of juggling.
I don’t have experience with triple positive and chemo prior to surgery but i do agree that you need to be comfortable with you surgeons and your plan. And ideally be sure that your breast surgeon and your plastic surgeon are on the same page since they will work together in the OR regardless of your reconstruction plans.
I do feel your pain on wanting to be done. You’ve described some significant complicating factors (low platelets for example) so I’d encourage you to have frank conversations with MO and surgeons. Do they work together and review patient progress? I felt that my BS, MO and RO talked about me during the process of treatments.
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Runrcb:
Yeah I was thinking people probably start gifting themselves those cosmetic surgeries around this time, and my surgery will be long.
I do believe my medical team works together and communicates. That is one reason I chose the facility I did. It was set up to be a little more comprehensive than the others.
I would just really like this out of me now. I was misdiagnosed initially at a different facility and it was allowed to grow in me for two years because of that. When I was properly diagnosed, my doctor who ordered the tests and who has been practicing for decades told me it needed to come out ASAP. Then the path report came back as aggressive as it gets, I find out they want to leave it in and do chemo first, it grows half a cm in the month before chemo and can be seen poking out from my breast, the chemo seems to shrink it, and then the PS wanted to push the surgery date way back during which time I won't have anything stopping it from growing again. It's been a bit nerve wracking and I really don't want my life taking a back seat to a nose job if that's what it is.
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