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Pathology report-approaching dcis
Hi,

My doctory just called me with the results of my biopsy. The report says APPROACHING the lowest grade of dcis. I asked my doctor if this means benign or malignant, and he said inbetween. I asked my doctor if I need a lumpectomy or a mastectomy and he said he doesn't know, and referred me to an oncologist. The report also says atypical ductal hyperplasia. Has anyone had the same result from a biopsy report ?  Does anyone know if my findings will require surgery?
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Page 6 of 6
962875 tn?1314213636
I'm sure that all of these terms, medications, and procedures are very confusing, when you've never had to deal with them before.

It's good that you are both asking questions and doing research on your own.

Regards,
bb
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I am wondering how badly I will feel during and after radiation treatments. I heard that my skin won't feel good and that I will feel exhausted. Are there other side effects? Usually I have a high threshold for pain. How exhausted will I feel? Well I have trouble doing my chores? Will I feel the exhaustion immediately when starting? How long does it take for the side effects to go away? Will they stop with the last treatment?
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962875 tn?1314213636
As with medications, reactions to radiation vary from one person to another.

Tiredness can be a side effect, but many of our members have continued to work during their radiation therapy. (Had an early tx each day,  then went on to work.)

The skin can feel "sunburned" but there are lotions than can be applied after each  tx (but NOT before!) and some good prescribed topical medications are available if  there is a more severe reaction such as blistering . I'm sure the radiologist's office will have handouts with all of the instructions and suggestions that will help you get through this.

We've had lots of posts in the past by members who have had radiation, helping others to know what to expect, so if you put "radiation side effects" or something like that in the "search this community " box at the top of this thread, to the right, I bet you'll find a list of many past threads on that subject.

A suggestion: Try to taking things one step at a time, if you are feeling overwhelmed by considering all that you are, or might be, facing.

Hang in there,
bb.

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Hi butterfly2222,

It is very encouraging to know that some women went to work right after a daily dose of radiation. Again, thank you so very much for your intelligent posts. They are very helpful for me. Hugs!
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962875 tn?1314213636
Thank you for your kind comments.

Hope you are having a good day,
bb
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I went to see a great breast oncologist surgeon and a great radiology oncologist today. My surgeon scheduled an mri for Wednesday, and I have another appointment with him on Wednesday to get those results. . I am having re-excision surgery and a snb on Monday Aug. 1. My radiology oncologist said assuming we don't find anything else I will have 4 weeks of radiation. So 20 sessions all together. I asked my radiology oncologist if he thinks I need ht, and he said assuming nothing else is found that I don't need it. I would still need to get clearance from my medical oncologist. I feel better emotionally after seeing both doctors.
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Hi butterfly, How are you this evening? Can you please tell me how uncomfortable an mri for my right breast will be, and exactly what happens? Thanks so much for all your help.
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Hi Butterfly, I forgot to ask you another question. I am going to need a durgical drain. How does that work? Is it uncomfortable? How is it cared for etc?
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A typo in my last post surgical and not durgical lol
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Hi,

Does anyone know why my radiology oncologist would have decided on 4 weeks of radiation for me and not 6 weeks? It will actually be 3 weeks and a week of boosts for a total of 20 sessions. Besides seeing my radiology oncologist today I also saw my surgeon, and I was more focused on asking him questions. I forgot to ask my radiology oncologist why 4 weeks and not 6. Of course, I will be seeing him again before the treatments begin, so I can ask him then. I was just wondering if someone on here knew why or if they had 4 weeks instead of 6.
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My surgeon said that when he is doing my re-excision surgery that he is going to lift my breast. Does anyone know if insurance will cover a lift to my other breast?
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Hi, Kate,
To answer your questions:
I've had several breast MRIs and can tell you they're not bad, but that can vary from individual to individual. An IV contrast is used, so they'll put in a small needle and tube that locks off into your vein (no IV bag of fluid---it's called a Heplock). About halfway through the MRI they flush it with saline to be sure it's still in the vein and open, then attach the contrast syringe and inject it. Also, there's no such thing as a right or left breast MRI, they always do both. That's because you'll lie on your stomach on a special table with your breasts hanging down between two holes. I've never had sterotatic , but I think it's similar to that. They give you earplugs and you're slid into the machine feet first. There's no pain, but there can be discomfort related to positioning. I first had my arms stretched straight out in front of me and because of shoulder problems, I did have a pretty painful shoulder during the MRI. You can't move at all and the test can take 45 mins or so, so by the end of it, I was very uncomfortable. At other MRIs, the techs positioned my arms differently and it was much better. Another issue is claustrophobia, which can be controlled with mild sedation (Valium for example) if you have someone to drive you there and back. Nausea from the IV contrast usually isn't a problem for most women, but it was for me. I resolved that by getting the earliest morning appointment and not eating at all before the MRI. They require you not eat or drink two hours before, but I found if I had eaten and had a later appointment, I'd get nauseous. The biggest problem with that is that I was breathing deeply to avoid puking, and that caused motion on the films---I had to repeat the whole test, and I wasn't happy about that. Overall, it's a relatively easy procedure and if there happens to be any issues, they can easily be resolved. You should talk with your doctor ahead of time regarding any questions or concerns you might have.

I've never had a drain with any of my excisional biopsies. As far as I know, it isn't necessary with a lumpectomy but this is something to definitely ask your surgeon.

I don't know about the radiation---maybe someone else has some information. Again, you need to talk with your radiology oncologist.

You'll need to contact your insurance company regarding a lift to the other breast. It may be covered as "reconstruction" related to BC, but they can answer that for you. With my three excisional biopsies there was never any lift done.

Hope this is helpful. Good luck with your surgery and snb. I'm hoping for the best.
nc
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962875 tn?1314213636
Hi Kate,

Glad to hear your surgery is scheduled, and not too far off!

Here is a link to a detailed description of the breast MRI procedure. It should answer any questions you might have:

http://www.radiologyinfo.org/en/info.cfm?pg=breastmr

There are laws/regulations that govern insurance coverage for women who need breast repair, reconstruction, etc., r/t BC. Since your surgeon is the one who proposed the lift of your other breast, I'd check with his office about the insurance coverage. I imagine they'll have to get it pre-authorized.

A surgical drain is a small tube put in at the time of surgery to drain off fluid that would otherwise accumulate in the cavity created by the surgery, causing pressure and swelling. The drainage is measured each day until it slows to a low level, then it is "pulled" leaving only a small hole that closes over and is hardly noticeable. (The drain is a good thing to have--just read some of the past posts by people whose surgeons didn't use one, and they had to repeartedly have fluild aspirated by a needle!)

Radiation oncologists use their expertise to decide exactly what treatment plan to prescribe for each patient. Apparently 20 txs are what he decided was best for your particular case. You could ask him how he reached that #, or just trust his professional judgment.

Regards,
bb
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962875 tn?1314213636
Sorry, didn't mean to duplicate your excellent answer.

It wasn't there when I started composing mine, so imagine my surprise when I clicked "post comment,''  and saw that you'd already taken such good care of Kate's questions...

Hugs,
bb
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Hi ncmichigan, I won't take sedation for the mri, because I hate side effects from medication. You do have me worried about nausea. They said nothing to me about not having anything to eat or drink 2 hours before. They told me to drink a lot of water the day before. My mri is scheduled for 10 am. I am going to call them when they open at 7:30 am to discuss nausea. Just like when you have anesthesia for surgery maybe they can add something to the iv to make sure you don't have nausea. Thank you for letting me know.
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Thank you very much for letting me know
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I had more bad news today, and I am worried sick. I had the mri, which wasn't problematic except for nor being able to move for 30 minutes. I had an appointment with my surgeon to discuss the results of my mri, He told me there was a problem area in a different spot in my breast. He had me take additional mammograms and an additional ultrasound. The radiologist told me that they didn't find anything, but this shadow on my mri could be dcis or it could be a vein. He said it would have to be closely monitored, and I would need another mri in 6 months. I am scheduled for my re-excision which my surgeon is now calling a larger lumpectomy, and a snb on Monday. I was so panicked that I couldn't remember whet the radiologist told me my options are. I think he suggested a mastectomy now or closely watch this suspicious area on the mri. Have you heard of this? A shadow that comes up on the mri, but mammograms and ultrasounds show nothing?
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962875 tn?1314213636
I'm sorry to hear you are having to deal with still another worry...

Yes, I have heard of things showing up on an MRI that don't show up on a mammo or US; that's the reason they are used in attempting to clarify certain situations.

However, such MRI findings can either be important new developments OR false positives.
(MRIs are so sensitive that they can over-read.)

Is your radiologist going to alert your surgeon regarding the MRI results? It is important that your surgeon consider this new information in planning your upcoming surgery.

Hang in there,
bb

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I'm also sorry to hear about your additional concerns, Kate, but panic doesn't help or change the situation. Take a deep breath, then try to follow bb's excellent suggestion back on July 23rd. Get your questions together and then follow up with both your surgeon and your radiologist on what's recommended. I've had things show up on MRI that weren't on mammo or US because MRI is more sensitive for certain things especially in women with dense breasts like bb said. According to the information below from the web site www.uptodate.com, DCIS is NOT one of them. Mammo & US are much better at detecting DCIS than MRI, so it could very well be a vein.
I have several 4mm. or less areas of enhancement, along with a 6mm. lesion in the left and and a 5mm.  probable lymph node in the right that the MRI radiologists have been watching every six months since Feb. '10. I have no doubt that if these were anything suspicious, the radiologist would recommend biopsy. It's always difficult "watching & waiting" but we do what we have to do. You said you have great doctors, so put your trust in them and address all your questions to them then follow their recommendations. They know your individual medical issues much better than any of us here and will cater your treatment to you as an individual.
In addition to bb's good information, I found this:
"Breast MRI — Magnetic resonance imaging (MRI) uses a strong magnet to create a detailed image of a part of the body. It does not use x-rays or radiation, but does require injection of a contrast agent into a vein. Breast MRI may be recommended to aid in the diagnosis of breast cancer in selected situations. MRI is not recommended to detect breast cancer in most women because it is not as good as a mammogram for certain breast conditions, such as ductal carcinoma in situ (a type of noninvasive or early breast cancer). In addition MRI testing is more likely to identify suspicious findings that turn out not to be cancer (false positives). "
Take care,
nc
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Hi Nc and Butterfly,

God bless both of you. You two always make me feel better. Yes my surgeon and the radiologist consulted. We all decided that the best course of action is the re-excisional surgery and sentinel node biopsy and then another breast mri in 6 months to monitor that shadow problem. Hearing that the shadow is usually not dcis and about false positives has made me feel better. I am sorry to panic after hearing bad news. Thank God I am not stage 3 or 4, but in other life situations I have had my share. Well sure enough I have another worry tonight. The surgeon who did my lumpectomy said on re-excision she was going to just take a small amount of tissue and my breast would look fine. She doesn't have as much experience as my new surgeon and she never even ordered a breast mri. My new surgeon said instead of calling it re-excision that he is going to do a wide lumpectomy and my breast will look considerably smaller. I am small to begin with so the appearance of my breast is of concern to me. He said if I am unhappy with the appearance he would get a plastic surgeon for me to fix things up. I told him about limited insurance and he said no problem he will get a plastic surgeon who is a colleague to do it with the insurance I have. I am sacared about the appearance of my breast, even though my tumor is 4mm I am concerned it spread to lymph nodes, even though doctor said it is a remote possibility, and I am scared margins won't be cleared this time, although that is what my new surgeon specializes in. My surgery is Monday I should get the path report on Thursday and the 3 day waiting period will be hell. Nc and butterfly thank you for your continued support I can't begin to tell you how much it helps me, and how much I appreciate it. Lots of hugs to both of you!!!!
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962875 tn?1314213636
No need to apologize for "panicking," cancer is a very scary disease!

The important thing right now is to try to get ALL of the cancer; appearance is important, too, but can be dealt with later, as your surgeon pointed out.

You mentioned "having had your share in other life situations." This leads me to believe you are stronger than you think.

Courage does not mean NOT being afraid, it means taking your fear, rolling it up in a lttle ball, putting it in your pocket, and doing what has to be done.

My impression of you so far is that, yes, you get very anxious about certain things, but then you go ahead and deal with them. Look at all you've coped with and gotten accomplished in the less than 2 months since you got the pathology report from your biopsy that launched you on your breast cancer journey!

Just keep hang in there,
bb
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Hi Butterfly,

Your impression of me is correct. I do tend to panic about certain things, but then I do what needs to be done. Normally I am resilient, but cancer has thrown me for a loop. Your post has made me feel comfort from a friend, and thank you so very much for it.
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While all of this is VERY scary, please use your energy to try to remain strong and positive and work at beating this disease. If you've made it through other life challenges, as we all have, you have to believe you'll make it through this one, too. It is what it is, and you just have to deal with it one step at a time. We wish you all the best with your surgery and we're hoping for a good report at the end of it. Hopefully, continued monitoring will show the shadow to be just that.
Sending you a hug (    ),
nc
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Hi nc,

Thank you so very much for your support. Words can't even express how much it means to me.
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Hi Nc, and Butterfly,

I had my wide lumpectomy, re-excision and snb yesterday. I am feeling ok, just a little bit of discomfort. I won't get the pathology report back until Wednesday or Thursday, but I have two pieces of good news. My surgeon did a preliminary test for lymph nodes, and he said mine were negative, Thank God. He also told me that he talked to the head of my hospital's radiology department, and he said the head of the department said it probably is nothing. I didn't get to discuss this further with him, because he told me this right before surgery. I have anxiety waiting for the pathology report, but I am going to stay positive thinking about the good news I have received so far. I will update again when I get the pathology report.
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I have an error in my last post. When I said the head of the department probably thinks it is nothing, I forgot to include that he was talking about the shadow on my mri.
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962875 tn?1314213636
Glad you are doing okay following your surgery, and that the news so far is good.

Keeping my fingers crossed in regard to your final path report!

bb
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Hi Butterfly,

Thank you again for your support. I will post again when I get my path report. I am a little sore now under my arm, but I guess that is to be expected. I am also feeling some slight nerve shocks in my breast area too, but I guess that is to be expected also.I hate to take pain meds, but my doctor forced me to take a pain med in recovery yesterday, because my blood pressure skyrocketed to 190. He said it was so high, because of the pain. Today with the discomfort I have I am not taking any pain meds, and I hope that is ok for my blood pressure.
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Hi, Kate,
It's good to hear the surgery went well and the snb was negative. It's good to hear that the MRI shadow isn't something to worry about, also. I'm sure they'll keep a close watch on that area. The pain you're experiencing sounds normal following your surgery. I'm a retired nurse and even if you hate pain meds, I'd definitely recommend you take them as prescribed, at least for a day or two. You can cut back a little if they knock you out too much, but if the pain isn't relieved you really need to take the dose prescribed. It will help the blood pressure for sure. Also, the only way your doctor will know if the pain is normal or not is if it's NOT relieved with the usual pain meds. If it's not, then you need to follow up with the surgeon to determine why not.
I'm hoping for a good path report and speedy recovery.
Hugs,
nc
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Hi nc and butterfly, I thank you both so much for your intelligent advice, and I have great news to tell you. I just came home from an appointment with my surgeon, My nodes are definitely clear, my margins are clear, and I am a stage 1. Thank God. I can't thank you both enough for your support. I will need to do radiation and possibly hormonal therapy, but I feel so blessed to just be stage one.
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962875 tn?1314213636
Wonderful news!

You've gone through a lot to get to this point, but now you know your prognosis is very good.

I hope everything goes well for you from here on out.

Wishing you all the best,
bluebutterbly
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Thank you so much. Your support has meant everything to me. While I was totally consumed with fear, you told me to be positive, and with your help I tried. I can't thank you enough, and I wish you the best that life has to offer. In my hour of darkness you and ncmichigan were there to ease my fears. Thank you!!!
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Hi Ncmichigan and Butterfly2222

I am considering to refuse to do hormonal therapy. My medical oncologist wants me to do it. My radiation oncologist said it is not necessary in my case. I know that I am er and pr positive. What I don't know is the percentage of how positive I am. Would the percentage make a difference in me requiring ht? I checked nccn and it said with a tumor less than .05 cm., grade 1, and no lymph node involvement I might not require it. Also, after 2 lumpectomy's I will require plastic surgery. Do you know if fat grafting or an augmentation with implants would be best?
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First of all, let me say how happy I am to hear your good news about your path report! I know you must be really relieved and I'm happy that bb and I were able to provide you support---that's what we're here for.
I'm not sure, but it sounds like you're refusing anti-hormonal therapy because one doctor says you don't need it. Are there other reasons for refusing? If not, what does your breast surgeon suggest? If two out of three docs recommend it, I'd certainly consider it. I know
there are side effects to consider, but some women have very little if any side effects. it seems to me that it's at least worth a try if it means preventing a recurrence of your DCIS.
If the side effects are severe you could always stop, but it would certainly be worth a try at least. You might want to consider a second opinion on it from another radiation oncologist and make a decision based on all the opinion.
I just read something today on WebMD re: fat injections after breast cancer.I tried to copy the we site info here but couldn't. Here's the article title and if you type it in at WebMD, I'm sure it'll come up:Fat Injections: Safe for Breast Reconstruction After Cancer?
Study Suggests Technique Known as 'Lipofilling' Has Low Complication Rate

It sounds like it's relatively new and mostly done in Europe. I'd discuss it with your plastic surgeon to see if it's even available and an option for you. If not, I I would think he/she would be your best source for all possible options and the pros and cons of each. From what I have read here, the cosmetic results are much better with your own fat/tissue, but it isn't always possible for all women. If it were me, I'd research it and check it all out and then go with the recommended option that has the best possible results with the least risk of complications. Just carefully review it all before deciding which direction to take. Sue Young has some great info on reconstruction and I hope she'll also fill you in on it.
Of course I wish you all the  best in making your decision and hope it all works out for you.
nc
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Hi Ncmichigan,

You bring up a good point regarding ht could possibly prevent a recurrence of dcis. I need to find out if my medical ocologist was basing his decision on my idc tumor or if he was basing it on my dcis. I am going to see my surgeon tomorrow, and get his opinion of whether he thinks I require ht. You mentioned that some women have little or no side effects. My doctor said that armidex or femora have less side effects than tamoxifen. Do you know which of the two armidex or femora has the least side effects?

Thank you so much for the info regarding breast reconstruction. I will study it. Also, when I see my surgeon tomorrow I will see what he recommends and which plastic surgeon he recommends. You and butterfly have been a blessing for me. In my hour of darkness you were both there to help, and I can't thank you enough!
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Hi, Kate,
From what I've read tamoxifen is used more often to prevent recurrence of DCIS and the AIs (aromatase inhibitors) are used more often for preventing recurrence of IDC. You'd have to ask your doctor's if one or the other is best for both. However, I did read that Arimidex seemed to do slightly  better at prevention than Femara but Femara had fewer side effects. There's also Aromacin, but I'm not sure if that's another option for you. Did any of your doctors mention the Oncotype DX test? It's supposed to give them an idea of what your risk of recurrence might be. I know it's helpful in determining if chemo is necessary or not, but I'm not sure if it's helpful in determining which drug is best. It may be something to ask your doctors about at least. I hope this is helpful to you and doesn't just confuse the issue even more.
I'm sure you'll find a good plastic surgeon and good luck with that part of your treatment.
Take care,
nc
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Hi Ncmichigan,

My doctor has mentioned starting with Femara. I am taking a bone density test today to see if osteoporosis is a problem. The side effect I am concerned about is hair loss or hair thinning. Di you know women who have experienced that as a side effect from taking ht? The reason I am concerned is that I once had Telogen Effluvium and it causes hair thinning, and I don't want to go through that again. My doctor's did not mention the onco DX test. They probably did not mention it, because they said that I do not require chemo. I will ask my medical oncologist about it. I am going to see a plastic surgeon today, and I am looking forward to getting started with that part of my treatment. As always you have been very helpful. Thank You
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Hi ncmichigan and butterfly2222,

After all that I have been through I am finally going to get a prize. I went to see a plastic surgeon today, and 1 month after my radiation is completed I am going to have implants for both breast and breast lifts. I start radiation next week. Again thanks so much for your support!
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962875 tn?1314213636
I guess every cloud really does have a silver lining!

I'm glad to hear things are looking up for you.

Regards,

bb
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Hi, Kate,
I 'm glad to hear you've found something positive in your situation, and like bb, I wish you all the best. I hope the radiation goes smoothly and the reconstruction does, too, so at least something good will come out of this long journey.
Take care,
nc
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Hi Butterfly2222, and Ncmichigan,

Thank you both for your support.
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Hi Ladies,

Since Miaderm cream for radiation is so expensive do you know of a good generic?
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962875 tn?1314213636
Here are a couple of ideas:

In an old thread, Sue Young55 made these comments: "There is no reason to go around with burns like that. Ask your doctor to prescribe Silver Sulfadiazine. The very minute your radiation is complete each day, apply it liberally to your burns. Slather it on!! But, before you go for your radiation the next day, make sure you are crystal clean and have no residue on you. It works like a dream! Remember to keep applying it until the burning stops in a week or so after radiation, or maybe sooner."

zouzi shared this information: "Healingwell advised me to apply Aloe Vera after each session. My oncologist didn't like that very much and would tell you not to apply anything! But I did. I made sure that before each session, that I showered and made sure that the breast was completely clean. The markings don't disappear and if they fade, the nurses keep remarking again. After my 15th session my skin started to suntan and become a little itchy, but the Aloe Vera and later Aveeno baby cream helped a great deal! My sister, on the other hand, had burns on her skin because she had 36  sessions, and never used any cream at all."

You should, of course, run any of this you might want to try by your radiation oncologist.

Hope you get through it without much problem,
bb
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Hi Butterfly,

Thank you so much. You are a wealth of information.
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962875 tn?1314213636
Other members have recommended: Biafine (which may also be too expensive), Vigilon (a patch to put on an area where a burn is starting to appear, also expensive), Oat Beta Glucan ("ordered by CVS pharmacist, about $50 per tube, but well worth it"),  Radioplex (a prescription gel) and My Girls' Radiation Cream ("all natural ingredients")--no cost info on the latter two.

bb
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962875 tn?1314213636
p.s. If you decide to use aloe vera, look for a brand that is as close to pure aloe vera as possible. Some formulas have other ingredients which may be irritating to the skin.

For example, some contain Vitamin E oil, which many people use to treat burns, sunburn, etc., but others may experience an allergic reaction to it which may be worse than the original problem.

bb
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Hi Butterfly,
Thanks so much for letting me know!
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962875 tn?1314213636
Hi Kate,

You are most welcome. Have you started rads yet?

I missed some of your earlier posts while I was on vaction. Here is a link to an article posted in Feb. 2011 regarding fat transfer for breast reconstruction:

http://www.wafb.com/Global/story.asp?S=14014920

bb
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Hi Butterfly,
I hope you enjoyed your vacation. Thank you for the link to the article regarding fat transfer. I had my 4th radiation treatment yesterday. Yesterday I noticed that my skin is starting to look darker. I am going to have 11 more regular treatments, and one week of boosts. Yesterday my RO ld me that the average person gets 1.8 radiation, and I am having 2.8. So I am getting a stronger dose of radiation in less days. I sked him how this would affect side effects, and he said I will do better. I am very concerned, because my skin is starting to look darker after only 4 treatments. Which creams for radiation do you think are best?
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962875 tn?1314213636
I believe the darkening is normal, kind of like a suntan.

Blisters or burns are also common, but more painful, so some kind of radiation cream or gel is recommended. I haven't had any personal experience, so I can't say what might be best. The radiation oncology nurses/techs probably get the most feedback from pts, so you might ask them.

Glad you've gotten started, because you are that much closer to finishing! :-)

bb
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