Am I nuts?

[katieo]

Last week I had a fine wire localization and exision biopsy on my left breast. Yesterday I received the pathology report indicating positive for Infiltrating Ductal Carcinoma (no special type)- Histological Grade 1, Mitotic Activity - low, SBR Grade 5.  I have another surgery scheduled for next Wednesday to remove some lymph nodes for axillary dissection.  The tumour was 1.2 cm at its greatest width and is Estrogen and Progesterone positive.  I'm really counting on it being Stage I.  

I've been thinking about possible treatments and have thought that I might opt for bi-lateral skin preserving mastectomy with implant reconstruction.

My right breast is very cystic and when I had a breast reduction a couple of years ago, the pathology report indicated Abnormal Ductal Hyperplasia on that side.  Even though the cancer is in the left breast, I feel like I have a time bomb in the right.

I am taking Estrace to control severe hot flashes and don't want to have to stop taking it.  I don't want to have to take Tamoxifan for 5 years.

Am I nuts?

One last question: why is sentinal node biopsy not reccommended if there has been past breast reduction surgery?

Surgeon, I'd appreciate a response from you as well.
Thanks.

[CCF-RN,MSN-JS]

Dear katieo, The first thing that would be recommended is to discontinue the Estace (an estrogen derivative), as it is contraindicated when estrogen responsive tumors are present.  Other non-hormonal treatments for your hot flashes could then be explored.

Because of surgical changes post-breast reduction surgery the lymphatic flow may have been altered which may interfere with the pathway leading to the sentinel node.

Regarding the decision about the local treatment of the cancer, the bilateral mastectomy with reconstruction is an option, and with your history, for you that may be very reasonable.  However going through all that, you would want to also consider what is recommended as adjuvant treatment.  Adjuvant treatment is treatment given after surgery to try to prevent or minimize the growth of microscopic deposits of tumor cells that might grow into a recurrent tumor.  At the least, because your tumor is estrogen receptor positive - hormone therapy to decrease estrogen in your body, would be recommended.

[surgeon]

So far, it sounds like a very favorable tumor. I agree with the answer above. There are pretty good data that taking tamoxifen for hormone positive tumors reduces recurrance and increases cure: the issue is treating the current tumor as well as preventing a new one. Were you to have bilateral mastectomy, the latter reason is moot. But you still need to give yourself the best chance of cure for the current tumor.
At minimum you'll need to stop the estrace. As to tamoxifen, well, the data are good, but the benefit for a very favorable tumor is there but not super dramatic. The answer above regarding sentinal node in a previously reduced breast is correct.

[katieo]

Thank you very much for the quick response.  

My surgeon told me that they're doing a study on Sentinal Node Biopsy and that I would be having both Sentinal Node and Axillary dissection.  

Will there be any benefit gained in staging the cancer or determining possible outcomes based on the information from the Sentinal Node since I've had a breast reduction?

Could the information be misleading?

[surgeon]

it won't be misleading: if they are doing both, it means they will do the sentinal node procedure first, and then the rest of the axilla. So if for some reason the sentinal node was not accurate, by testing the rest, they'll find out. It's really for them to test their own accuracy in doing the sentinal node procedure: you won't be at risk of false info, because they will go on to do the whole thing.