Mastectomy/flap reconstruction or Radiation?

I had a needle-localized excision on Feb 4.  Results were DCIS, non-invasive, hormone receptive.  I had a re-excision on Feb 20 and they found a few more DCIS cells outside but very close to the margin.  I had a re-re-excision this past Monday and the pathology report came back clear.  As a result of the two re-excisions a considerable amount of my left breast tissue is now gone.  My surgeon believes he could make the case to my HMO for a mastectomy and flap reconstruction because of how much breast tissue is now gone.  Or I can live with the smaller breast and go down the path of radiation to deter re-occurrence.  I

[CCF-RN,MSN-rf]

Dear Kathy Q:  There is no obvious "right" answer to your question.  Either treatment path is completely acceptable from a medical point of view.  This decision should be based on your preference both from the point of view of follow up treatment (radiation vs. no radiation) and appearance (smaller breast vs. reconstructed breast).  Each option has pros and cons.  You might meet with a plastic surgeon to discuss reconstruction and a radiation oncologist to discuss radiation so that you have all the information you can gather to make the best decision.

[surgeon]

It's entirely a matter of personal preference; the cure rate would be equal, essentially, between the two. So you need to decide between two very different treatments, each with pros and cons, and no one can really make a recommendation without knowing you well and knowing the anatomy in your case. You must balance having radiation and having assymetry of your breasts against a very large operation (and probably a couple of subsequent smaller ones) which is likely to have very good cosmetic outcome. A large part of the decision, I'd assume, would depend on how you and your doc think the breast will look after radiation, and how you feel about that, cosmetically speaking. If it's something you think you'd be pretty unhappy with, you would need to need to consider the reconstruction: be sure you have a detailed explanation of what's involved and what to expect with each option

[Kathy Q]

Thank you for your comments.  I have an appt with my surgeon today,  my radiation oncologist on Wednesday and will hopefully get a referral to a plastic surgeon this week to talk to each of them regarding my options.  I spoke over the weekend with a friend who  is going to help me figure out which plastic surgeons in the area are the best.  Unfortunately, because I belong to an HMO, I may have to change primary care physicians to be able to get the referral to a top plastic surgeon in the Boston metro area.  I really appreciate that you validate what my insticts are telling me to do.

[dammie]

You should also question the doctors of the effects of radiation of the breast in terms of a possible need for reconstruction in the future.  I was told that implant reconstruction was not an option on a radiated breast.   There are other reconstruction options, the choice is personal.   You need all the info to make the right choice for you.  I just had a bilateral mastectomy on 3/17 because I was not willing to take the risk of not having implant reconstruction  if needed in the future.  (Originally had lumpectomy, then chemo and was to continue with radiation - decided against radiation and to go with mastectomy after speaking with the plastic surgeon)  Good luck to you.  Take notepaper and if you can someone with you to help with some of the questions..

[Kathy Q]

Dammie,  That is an excellent suggestion to take someone with me.  One of the biggest problems I've had is processing all the information I've heard.  Even though I take notes, my denial filters are still in place and it's hard to synthesize everything so I can make an informed decision.  I have a friend who is a former nurse for a plastic surgeon.  I'm meeting with both my oncology radiologist and a plastic surgeon on Wed for informational sessions and I'm going to see if my friend is available to come with me.  I didn't know that about a radiated breast.  Thank You for your sensible and helpful advice!!!

[dammie]

Good luck Wednesday.  My prayers are with you.