Multifocal Invasive Lobular Carcinoma

[Jaquelyn]

My right breast was diagnosed with stage 2,1 node out of 13, HER neu invasive lobular carcinoma.

I had two lumpectomies and each time 3 invasive lobular cancer spots were found.  I got clear margins on the second surgery.  I have LCIS on 20 of 28 slides.  I am told I have multifocal invasive lobular carcinoma.

I have already had chemo and an MRI which did not show lobular cancer in the right breast.  It could have shrunk or it could be gone.

Statistics state that lumpectomy with chemo and radiation or mastectomy with chemo are the same for reoccurrence and it is a personal choice which to choose.  I am concerned that the statistics may not be the same for multifocal lobular cancer.  Because of the nature of the disease it is difficult to surgically remove the cancer with any certainty.  I have been told that reoccurance could be up to 40% with lumpectomy, chemo and radiation.  

Is that percentage of reoccurance less with a mastectomy and chemo?  
Thank you

I appreciate your time.

[CCF-RN,MSN-rf]

Dear Jaquelyn:  If the lobular cancer is multifocal, mastectomy, rather than lumpectomy and radiation, would be recommended.  40% recurrence rate is high.  Your chance of recurrence with mastectomy would likely be much lower. Incidently, depending on how many and the location of the foci, it is quite possible that mastectomy would be recommended for multifocal ductal cancer as well.  Also, mastectomy with reconstruction may offer a better cosmetic result than multiple lumpectomies (if this is important to you).  You should also discuss with a plastic surgeon whether reconstruction would be possible for you later if you have radiation therapy now.

[surgeon]

when there's multifocal disease, particularly when it's in more than one quadrant of the breast, the chance of recurrance is higher with lumpectomy/radiation than with mastectomy. If your doctors think you have 40% chance of recurrance with breast preservation, that's quite high. In general, unless there's a very large, locally advanced cancer (which you don't have, by your description) the chance of recurrance locally with mastectomy is l0% or less.

[Jaquelyn]

Thank you for your timely response.  

I have had a hard time with this decision and feel my chances are better getting a double mastectomy.  There is something in the outer left breast also but it is not defined.  A 6 month follow-up is suggested.

I am planning on getting a DIEP flap for a reconstruction of both breasts.  Any comment on pro or con of this type of reconstruction?  I have researched the different types and this seems like a good permanent solution.  I hope it is safe.

One concern I have is a site on the internet stated that you cannot find cancer in the chest wall until you get other symptoms once you had a DIEP flap over the muscle.  I am trying to find out if this is true. It seems an MRI would find it in the chest wall or anywhere else before it got too big.

Your site is wonderful and I hope to sleep better.  I want to feel better and that I am making the best decisions to live a long and healthy life.

Thanks again.

[CMeeh]

Did you have a coil MRI, where you lay face down in these cone type coils? I too had breast cancer 8 years ago in only the left breast but chose to take both because of the unknown and risk of developing in the other. As for reconstruction..I had the flap with reconstruction from my stomach, vascular, fat and muscle. My opinion I would never recommend that type. I have heard of very few happy results with that type of reconstruction, and the healing from this is so long and severe, at least in my case. I have done alot of research because i have 2 young daughters and I have heard that after radiation you skin can sometime not heal properly and have reconstruction of this type would be better being done before radiation. I have a close friend who is right now dealing with this type of situation!

[Jaquelyn]

This is for the surgeon.  Please read C4. I posted it incorrectly yesterday.

Thank you

[Jaquelyn]

I had an MRI with both breasts dropping in a hole in the table.

Did you have a TRAM flap reconstruction?  I am looking at a DIEP flap where they are supposed to spare the muscle in the stomach.  How long was your recouperation?  Would you do no reconstruction at all now?  I just don't know about the implants.

Jackie

[VLMS]

I had a DIEP done in November on the right breast. I had invasive ductal breast cancer. The DIEP was wonderful compared to all the problems I read about other prodedures. Not using the muscle makes it easier to heal. A great book to get is the Breast Cancer Reconstruction Guidebook from Beginning to Recovery by Kathy Steligo. It will answer a lot of your questions. The DIEP is the best way to go. I have no regrets. Good luck. My DIEP was done by Dr. Rosenbaum in Miami, Fl. Be sure that your doctor is well qualified because it is a complicated surgery. There are only about 12-14 surgeons that perform it in the US. If you have any questions my email address is ***@****.