DMX before radiation or after?

July152020 · November 2020

I had lumpectomy before knowing my dna result and I also really didn't expect it to come back brca-2 positive. Anyways, so I had lumpectomy on 8/12 and now on chemo.

I am currently on short disability leave and will exhaust it after I finish my chemo.

After I learned my dna result I talked to my surgeon about dmx and he recommended getting DMX after radiation and so I probably have to wait 6mon-1 year. Then I went to a cancer center to get a 2nd opinion and she said over there, the plan is usually DMX after chemo and before radiation (maybe it’s for the her+ patient).

I guess me rushing to get lumpectomy really complicated things a bit. I wanted to get DMX ASAP but then I'd have to apply for long term disability and who knows if I will get my position back or not (not important). My real concern is I read some other women's experience which looks like after radiation the skin might not heal well with DMX. If that's the case I'd push my surgeon.

I am interested to hear more stories from each side so I can make up my mind about when to get DMX.

thanks.

Update with some more details.

MinusTwo · November 2020

If you are HER2+, it's usually chemo, then surgery, then radiation. Chemo first to shrink the tumors. Otherwise I think your first surgeon is incorrect. If you have your BMX and tissue ex panders in before radiation, the eventual implant placement won't have to deal with radiated skin that doesn't move. It's more complicated, but I'd vote for surgery & TEs before rads. You can always have fat grafting with you exchange to implants if necessary.

Hopefully you're talking with a plastic surgeon and not just a general or breast surgeon. In my case the BS did the excision and removed the cancer & the breasts, and the PS took over & put in the TEs and closed.

MikaMika · November 2020

Hello,

Could you please share why your health care team recommended radiation with mastectomy? As I can see your tumor is small and you had ALND.

MinusTwo · November 2020

I didn't have radiation after the mastectomy and getting my implants. It was DCIS & other issues, but I thought I was finished.

But two years later I had what they called a "local recurrence" in a lymph node under my collar bone. Because it had turned to IDC and was now HER2+, that's why I had chemo. And then an ALND. And then more chemo because I didn't have pCR with the first chemo. And then rads. And then herceptin for the rest of a year. Still NED 7 years after the last treatment.

MikaMika · November 2020

Thanks MinusTwo for your response. I had radiation too. In my case my cancer center recommended radiation after BMX since my tumor was multifocal ILC. On the other hand, second opinion advised against rads. I always thought that surgery is most important than radiation.

Congrats on your NED status!

July152020 · November 2020

hi minus2,

My tumor is her- and I don’t want reconstruction. The reason why I had lumpectomy first was because I didn’t know my dna result before my surgery.

So maybe in my case maybe it doesn’t matter?

MikaMika · November 2020

Hi July152020,

Are you sure you will need radiation if you are going to have mastectomy after chemo?

July152020 · November 2020

Mika,

Yes, I have two nodes positive.

Cowgirl13 · November 2020

I think you definitely need a second opinion.

MinusTwo · November 2020

I agree. A second opinion at a different facility. Hopefully you can go to an NCI designated cancer center for your second opinion.

DeniseML · November 2020

Minus Two,

I'm in the process of deciding to do TE at time of mastectomy and before radiation or wait. spoken with SO and PS. left me with more questions and no real decision yet. Thankfully I have 2 more chemo treatments before Surgery can be booked which will be in January. PS states risk of complication post-mastectomy when TE placed immediately increases to 20%. Interested how everyone made out who had TE placed immediately. part of that risk increase was due to radiation with TE in place. I am having a hard time making a decision. I do not want to delay further cancer treatment due to a complication that could be avoided. Then again, neither do I want to add an additional delay to reconstruction. I will also be having Immunotherapy to continue until September 2021 and for a further kick, Kadcyla ( drug conjugate ) possible if pathology not clear. considering the locally advanced stage, this is a real possibility! Second question; has anyone had their SO refuse to do prophylactic mastectomy on other side at same time? My SO insist my risk of recurrence on other side is no more than her being diagnosed with BC, after tri-modal therapy. stated best to do Proph. mastectomy at time of reconstruction, if I still want it, for cosmetic reasons . Spoke with PS after that and this explanation was not confirmed by him. Will be difficult to match both breast at anytime because of radiation on left. HER2+ status, ER/PR negative. I'm not finding much information on determining risk of recurrence for HER2+ BC. Little I found related to tri-modal treatment does back up what SO stated re: Risk, but did not specifically mention HER2+ . Sorry for long rant! Does anyone wish they hadn't done prophylactic mastectomy ?

I wish everyone the best and thank-you for these postings. will keep you in my prayers!

MinusTwo · November 2020

It is your right by law to have the other breast removed at the same time - for symetry. If your surgeon doesn't understand that, you really do need to have a 2nd opinion.

DMX before radiation or after?

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