Anyone have a reduction of non-BC breast at time of lumpectomy?
I had a second surgical opinion this morning that left me even more overwhelmed than I was before. Mostly because the surgeon (a woman) asked me if I wanted to have a reduction of my non-BC breast done at the same time as my lumpectomy. My original surgeon (a man) had made no mention of this at all, so I asked her why would I need that and she said that, between the loss of tissue from the lumpectomy and the shrinking of the breast once I have radiation (also never mentioned by the first surgeon), the non-BC breast would be noticeably smaller, but that they could go ahead and reduce the other breast to make them a closer match. (I questioned whether insurance would pay for that, and she told they generally do, which surprised me.) The only issues with doing that would be that I would need to be out of work for at least a week longer for the recovery and should they need to go in again to get better margins, that would be somewhat more difficult because the PS would probably "move around" some of the tissue in the BC breast too. But she said she's done it before and was not worried if that turned out to be the case. Have anyone else done it this way?
Also, I was very surprised by the amount of small differences between how the two surgeons handled the appointments. The first surgeon's office was very organized and gave me a literal textbook on BC, plus business cards for everyone in his office who would be involved, handouts of the ER/PR info, etc. The one today seemed a lot more casual and less organized and gave me no printed info at all, but the doctor spent much more time with me and seemed to be a lot more concerned with my long term physical situation as a result of this surgery. She also ordered an MRI, which the first guy said was "unnecessary". I generally liked her approach better, and certainly liked the fact that she wanted more testing and had more concern for the future, even though switching to her group will take me out of the hospital system (and actual hospital) I am familiar with from all my other doctors and prior surgeries. Of course, I know that my "hospital comfort level" is not the priority here; the best treatment is. But it sure would be nice if her office was as organized, as that would give me some comfort in return for giving up the "hospital comfort". But I guess you can't have everything.
Comments
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My MO mentioned a reduction on the non-BC side back in 2016 (when I had a LARGE chunk taken out). I asked her if anyone would be able to notice the difference when I was wearing clothes and she said no so it was an easy decision not to do it. I figure we're not symmetrical anyway, right? So why do an unnecessary surgery? As to how to choose a surgeon, I honestly think that outcome-wise it won't matter. Where I live, there are two options--a large, public hospital and a smaller, private one. The general consensus is the larger one is better for really weird diseases/injuries/treatments, but many go with the private hospital for more standard things (like a lumpectomy) because they have a better "bedside manner" reputation. It's a little more personal, no medical school students, . . . . Re: the MRI, my guess is the first surgeon would order one if pressed? I had one in 2016 (after being warned about the high number of false positives), but did not have one in 2018.
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Thanks for the reply Ingerp. It's funny that prior to all this, I would have agreed with most of your thoughts on these issues. However, in the two weeks since I've been diagnosed, I have already learned a huge amount of things about myself that I would have never guessed. Most of them have been related to how I am handling things as a single, childless woman with no family nearby. For example, I would never have guessed how strongly I have felt about saving my breasts, at least for now, as much as possible. I am apparently more vain and concerned about dating in the future, etc. than I would have thought! Prior to actually being diagnosed with BC, I would have said that if I ever were, I would just get a double mastectomy right away no matter what, and probably without reconstruction, just to cut the risk and be done with it. I have also learned that, because I am basically going to have to handle most of this whole process alone (other than having my sister-in-law with me for a few days around my surgery), that I really want to have a connection with my doctors in this. I want to like them as people as well as feel confident that their medical skills are good, which in the past I would have said that that wouldn't really have mattered to me. I feel the same way about the hospital, though I think I can forgo that part of it for the "better fit" doctor.
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Just came across nyama's thread about oncoplasty that was started in 2013. This is EXACTLY the info I was looking for when I started this topic thread! (Just hadn't heard that term for it, so didn't know to search for it!)
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Karen, I'd choose the surgeon who spent time with me and was proactive in ordering an MRI (this is standard in many cases) and who was concerned for your future. It's like choosing the one who cares over the handouts. Good luck. BTW, I had about a 5.5 chunk on my breast taken out and did not do a reduction on the other one. My surgeon asked me later if I was ok how it turned out and at that time, I couldn't imagine another surgery. So now i wish I could have the reduction but I am afraid of the side effects of surgery.
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Cowgirl, After 24 hours of thinking about it and reading the whole oncoplasty thread, I am definitely going to go with the second opinion surgeon and the oncoplasty. And your post was a confirmation of that decision - I really don't want to regret not doing it all in one surgery when I have the opportunity. (And if you haven't read the oncoplasty thread by nyama, take a look at it. There are a lot of really positive posts that might convince you to at least talk to your PS about the possibility of having it done now.)
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Hi Karen,
I had this done. I met with the BS first, a woman, who discussed how I was a good candidate for lumpectomy. It was her nurse navigator (oh how I love that woman) who mentioned she often worked in partnership with a PS (a male) and recommended I see him about a reduction in the healthy breast and .......joy of joys....a lift of both! I wanted something nice to come out of this so I went for it. The other benefit was that this freed up the BS to "go for the margins" as I told her. Have at it. So, she didn't have to worry about taking too much. It was one surgery. She went first. Removed the lump with generous margins, and did the SN biopsy. Then he came in and finished everything up.
Recovery did not take any longer at all. I was perfectly fine within a few days and only took off a week of the two I had planned at work. Everyone is different of course, but in my experience the plastic surgery added nothing more to the recovery. I left the hospital with two drains, one for the SN and one for the reduction. They were out in 48 hours. It was outpatient. I think my husband said I was in the OR for 2 hours. The scars aren't bad at all, and are gradually fading. I'm delighted with my smaller and perkier breasts and it is something nice to come out of this nightmare. I was a 32D/30DD when I went in, so I had the advantage of plenty of breast tissue to be removed. I just finished radiation so I don't know yet what my new bra size is. I suspect I'll be a B or at most a small C. Works for me!
Hope my experience helps.
ETA: The PS (whom I also just loved) warned me that sometimes sensation is lost in the nipple, and this did happen, on the formerly cancerous breast. I can live with it.
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Also Karen, I agree with Cowgirl. My BS ordered the MRI first thing to make sure that nothing else was going on and that lumpectomy was the way to go. It's a wise thing to do if it's offered to you.
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Karen--it's great that you're taking a good, thoughtful approach to this. We all come into the experience from different directions, and yes--there is a good bit of self-learning that often comes along with it (like I had no idea how invested I was in my hair!). I should tell you I've come across several women who like their "new" breasts much more than their old ones!! It's all going to work out fine.
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Ladies, I soooo appreciate your advice and the stories of your personal experiences! As of yesterday, I canceled the surgery I had scheduled with the first surgeon I met with and officially signed up with the second surgeon. I had my MRI this morning and have a consult with the plastic surgeon my BS works with on the 12th. I am also making a preop evaluation appointment with a physical therapist (also recommended by my new BS) who specializes in breast cancer recovery to get a jump on everything I will need to deal with post surgery in terms of movement, possible lymphedema, etc. Having all of this done presurgery is giving me a much more confident feeling about the process in general than I had after meeting with the first surgeon, who didn't even mention ANY of this! It is just amazing to me how differently doctors can practice! And without the members of this forum community, I wouldn't have known to question any of it. Thank y'all so much for helping me educate myself!!
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Karen, how fabulous your BS recommended the physical therapist who specializes breast cancer recovery. So glad to hear this.
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that’s great Karen! Good luck!
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Hi Karen,
I also had a reduction and lift on my non-BC side. It was the silver lining as my BS called it. Similar to your situation, I had consulted with a BS in the hospital group where my PCP was, but I wanted a 2nd opinion. Loved the BS and PS, so they did my surgery. Wanted to stay within THAT hospital group for chemo but really wanted to do scalp cooling but the MO was totally against it, said it didn’t work. So another 2nd opinion sought for an MO in yet another hospital group, and what do you know, LOVE that MO and RO!! So now I have doctors in 3 different hospital groups but I’m very comfortable with their care!
As for the oncoplasty, the girls are very perky but the PS wouldn’t go as small as I wanted to go. I was a 38DD and am now 36D. The problem I have is that I now have breast edema on the BC side. Not sure what caused it and the LE nurse has me wearing a snug sports bra 24/7 and doing massage. So now even after radiation, my BC side is bigger. Hopeful I can get it smaller eventually.
Always advocate for yourself and ask lots of questions. They have the knowledge you need to be able to make the best treatment decisions for YOU!
Kim
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I had a lumpectomy two and half years ago. My breast was already smaller on that side and the radiation shrunk it a little more. So I had a very noticeable discrepancy between the two sides. I wasn't ready to proceed with a reduction until now, but I am so glad I did. I am a little over a week out and the recovery has been a breeze so far. I told my plastic surgeon I wasn't expecting perfection, but just wanted them to look reasonably symmetrical. I am very pleased so far!
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Yes, I had this. My BS did the lumpectomy, then the plastic surgeon followed immediately with a reduction (non BC side) and a lift on both. Same OR and easy recovery. I went from a DD to a D.
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I had a lumpectomy in 2000 that removed a golf ball sized lump. I had no radiation -- the surgery alone made me lop sided. I was never asked if I wanted the other side reduced and just went forward with the two different sizes. Eleven years later, I was wanted my breasts reduced and made even. I expected to bear the cost of this surgery. I was surprised when the plastic surgeon told me that since I had bc in the past, insurance would pay and that I could have had this surgery at the time of the lumpectomy. I could understand insurance covering the surgery to make the breasts match but not why the reduction of the non-bc side was covered. She said it was because smaller breasts mean less tissue to support cancer in the further. So glad I did it -- made it easier to exercise and lose weight. Polly
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I am so grateful for everyone's replies! Y'all make me confident I have chosen the right surgeon and the right surgery. Now I'm just keeping my fingers crossed that my genetics results and MRI result don't change anything, because at this point, I'm (almost) looking forward to my "silver lining" surgery!
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Karen - I had a large lumpectomy (partial mastectomy) a bit over a year and half ago (3/18) and then radiation. I had breast tissue "moved around" as well. That breast is significantly smaller and the scar is pretty big. It's on the left and when I sleep on that side for a long time it can become down right painful. Then it also becomes itchy at times. I have seen a PS who says he can lift the scar and fill in some of the breast with fat grafting and some point would lift the other (sagging) beast to make it look more like the reconstructed one. It seems to me that since you don't know what you are going to be left with, perhaps you need to wait till all of the treatment and healing is finished before having the healthy breast worked on to match.
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Gussy, my BS feels like, because my tumor is small (1.2cm), she will be able to remove it and get clean margins without significantly changing the size of that breast. And as I am single, working full time, and without much family support, I would like to keep from having to have any additional surgery if I can. If the PS she has me meeting with next week feels differently, however, I will definitely consider his advice.
Just curious, was it a PS or your BS who "moved around" the tissue during your surgery?
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I also had what they call here in Ukraine a symmetrization so now I have a pair of nice perky 75Bs (instead of rather sad 53-year-old Cs). They did not use any tissue from other parts of my body, just reduced the good breast to match the affected one. Both nipples were moved up so now on each breast I have a scar from the nipple down and another under the breast (plus one in the armpit after the LN). I have not started my radiotherapy yet and I am about one month post-op. Both breasts look the same size though, as I read here, this may change after the rays.
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I had a reduction done on both breasts when I had my lumpectomy. Healing was easy and I was surprised that I didn’t have a lot of pain. My only issue is that the plastic surgeon was supposed to make my cancer breast 20% larger because I would be having radiation on it and it would shrink. My breasts looked great when he was finished but now the radiated one is noticeably smaller. Either he didn’t make it 20% bigger or it shrunk more than expected. Decided to live with it because I really don’t want another surgery.
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hi Cowboy andKaren- what you have as reduction is looks like Goldilocks type surgery??
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I'm having this surgery too! Glad to hear it's worked out for those that had it. I'm worried my breasts will be too small in the end, I'm a small D large C I don't really want to end up with A's or even B's especially since I'm not thin.
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For anyone else wondering, here is a link to the oncoplasty/lumpectomy thread started by nyama in 2013. I haven't had a chance to read through it or any other info yet.
https://community.breastcancer.org/forum/91/topics/805399?page=1#post_3604965
This is all new to me. !!! I knew that with mastectomy one can have reconstruction/plastic surgery to improve aesthetics. I honestly didn't know that it might be something I could have with lumpectomy. I guess I figured probably so if there was significant disfigurement. HUH. Didn't know.
So now I wonder if there are limits on who is eligible. Does it depend on breast size or how much difference in size there is? Thanks for any info.
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Dewey and Mia,
From what my surgeons told me and what I've read online, the surgery works best for larger breasted women whose breasts have begun to droop and flatten. I'm 52, a D cup, and that DEFINITELY describes mine! This type of breast allows for them to have enough tissue to "rearrange" after the lumpectomy to create lift and fullness, and nipples that are low enough to be "lifted" without looking too high on the breasts afterwards. My PS told me that they really can't predict what size you will be afterwards, because it all depends on how much tissue the BS removes to get clean margins.
I definitely recommend reading nyama's thread for more info from women who have already had the procedures. My surgery is next Monday, so I will report back with how it goes!
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Everything Karen said is my experience as well. I nursed my son for two years, the BREAST surgeon took one look at my formally beautiful perky B's, now droopy D's and said "HEY! BRIGHT SIDE!" Talked to the plastic surgeon and he agreed. I am delighted with my new breasts and it truly has been a bright side to all this. But I'm vain as hell too, so there's that.
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