Hi. i just lost my question just as i was going to submit it... so here goes again.... I just schedule bilateral mastectomies with immediate reconstruction with implants. Although my tumor is not large (1.8cm), I am very small breasted and they would habve to take a litlle over 1/3 of my breast to get clean margins with lumpectomy. Radiation may shrink my breast further and I could end up with a breast 1/2 the size of theother. Therefore i have decided on masctecotmy with implant. I am choosing not to do reconstruction with my own tissue at this time because I am pretty fit and don't want to give up muscle (nor do I want extra scar) and I was told i do not have enough excess tissue to build a new breast. Because I would like my breasts to match, I have made the tough decision to do bilat. mast. I do like the idea of avoiding radiation (although I may still need it if + nodes). Am I crazy? Is it overkill to remove a healthy breast as well. By the way, my onco score is 28 which means I have an 18% chance recurrence with Tamoxifen alone. Has anyone else made a similar decision? How do you feel about it now? Thanks, Kelly
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Kelly, most surgeons consider it "overkill" to remove healthy tissue unnecessarily. But most of the women I know who decided to have a bilateral are glad about their decision. Usually, women choose a bilateral because they have a high risk of cancer in their other breast. However, some women make the decision based on the balance and symmetry issues that concern you. Discuss the pros and cons with your doctor and then make the decision that feels right to you.
Hi Kelly - You might want to read this post on Jessica Queller, a woman who chose bilateral mastectomy due to carrying the BRCA gene; it is indeed a tough decision to choose to lose both breasts. Make sure you take the time, as Phyllis says, to discuss this thoroughly with your doctor; and to understand the sequence of events your treatment might take (if you need radiation, for instance, make sure the reconstruction surgeon and radiation oncologist have connected). Also, if you do go this route, insist on physical therapy after surgery; you'll need to do some work to get your range of motion back.
Also, don't jump the gun with the Oncotype score, and what it means. That 18% would shrink considerably if the cancer hasn't spread to any nodes. You need your complete pathology report before you can determine exactly what treatment you'll have, and how it might impact your recurrence rates. Interestingly, having a prpphylactic mastectomy does reduce your risk of a new cancer in the healthy breast, obviously; but it doesn't raise your 5-year survival rate – which, as I said, should be pretty high with no node involvement. Good luck - PJH
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