Hopeful, sorry that you've been diagnosed again. Is this DCIS in the same area of the same breast, i.e. most likely a recurrence and not a new primary breast cancer?

If this is a recurrence, I don't know if you have a higher risk to recur again. That's a good question for your surgeon and oncologist.

If this is a new primary, well... unfortunately all of us diagnosed one time with breast cancer, whether invasive or DCIS, are higher risk than the average woman (who has never had breast cancer) to be diagnosed again. If you've had two diagnoses, are you higher risk again for a third? I don't know, but logically if your breast tissue has shown that it's a friendly environment for growing DCIS cells, I suppose the risk might be higher.

As for whether reconstruction makes finding a recurrence more difficult, I think it depends on the type of reconstruction. I have a sub-pectoral implant, which means the implant is placed behind the chest muscle. This type of reconstruction is less popular today but was pretty much the only implant reconstruction option when I was diagnosed 15 years ago. The benefit of having the implant behind the muscle is that it pushes the muscle and skin tightly together, both on top of the implant. With a smooth, flat and taut surface on the reconstructed breast, any recurrence, whether against the chest wall or against the skin, will be quickly noticeable as even the tiniest of nodules. So certainly for this type of reconstruction, monitoring for recurrence is as easy as going flat, and a lot easier than after a lumpectomy. I can't speak for other types of reconstruction but hopefully someone comes by who can.

Hopeful, for me there wasn't a choice. I would have opted for a lumpectomy but with 2 areas of high grade DCIS totally over 7cm in size, in a small 34B (barely!) breast, a mastectomy was my only option. But since I never wanted a MX in the first place, I just couldn't go to having a BMX, so I had a UMX. I didn't want to deal with being flat on one side and honestly, I didn't think that emotionally I could deal with such an obvious daily reminder of my diagnosis, so it was never an option for me to not have reconstruction. But my goal was merely to even myself out and to have something to fill a bra; I wasn't interested in any of the more complex reconstruction options that involved harvesting from other areas of the body. Implant reconstruction, while less natural in appearance, was fine with me.

I was lucky - I had no problems at all with the reconstruction process. I did have an expander and while some people find them to be uncomfortable or even painful, it didn't bother me at all. I was actually fascinated by the process through the whole thing. But not everyone is so lucky, and unfortunately there is no way to know in advance if you will breeze through reconstruction, as I did, or if you will have pain and problems.

Have you seen this thread? It's in the DCIS forum, so most of the answers are from those who've had DCIS, although a few invasive cancer patients popped in to comment as well - but some of the issues are different in the decision making for DCIS vs. invasive cancer.

Topic: lumpectomy vs mastectomy - why did you choose your route?

And again, to your first concern about reconstruction making it more difficult to find a recurrence, with sub-pectoral implants, it is extremely easy, possibly easier than going flat (because flat unfortunately isn't always flat) to find either a chest wall or skin recurrence. To me, that was a real benefit of this type of reconstruction.

hopeful, sub-pectoral vs pre-pectoral is a difficult decision. It wasn't one that I had to make, since pre-pectoral wasn't done back when I was having my MX.

I think that the answer as to whether finding a recurrence is hindered by a pre-pectoral implant may be different from a patient's vs. doctor's perspective. A chest wall recurrence or new primary will not be palpable, as it would be with sub-pectoral implants, but would be detectable with imaging. Take a read through the following recent thread. While this wasn't the topic of this thread, the discussion did cover this issue. Read from my post of Dec. 5th 11:27 a.m. onward (mid-way down the first page).

Topic: largest cc for direct to implant?

Congrats!