Breast Cancer Community
Time allowed between diagnosis and surgery, etc
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This patient support community is for discussions relating to breast cancer, biopsy, genetics, chemotherapy, hormone therapy, lumps, lumpectomy, lymph node dissection, lymphedema, mammograms, mastectomy, radiation therapy, reconstruction, and self exams.

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Time allowed between diagnosis and surgery, etc

Ok!  I was diagnosed with Invasive Ductal carcinoma of the left breat, grade 3
Going for 2 surgical opinions, 1 on Monday the 19th and the other on October 5.
My MRI is scheduled for next Wednesday
My core biopsies were done on the 31st of August,  my pathology report was received on the 9th of September.
My worry is with my aggressive form of breast cancer, how long can I wait from diagnosis to surgery before the tumours get bigger or spread.  My GP says I could wait weeks?  Is this true>

Kindly
Diana
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13 Comments
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739091_tn?1300669627
Your Doctor is right. It's really important to get all your tests done before choosing a surgery type.

Example: I had a mammogram come back with no issues. However, I had a cyst and it didn't show up on mammogram so they did ultrasound. Ultrasound showed 1.5 cm mass with tentacles, biopsy showed cancer. MRI showed it to be 10 cm invasive lobular carcinoma. Surgery was mastectomy (after 4 rounds chemo because mass was so large) and pathology showed it had spread to 3 out of nine nodes.

So you see, each piece of the puzzle was determined from each different test. Pathology showed even more. These tests are very important. Take the time and if you feel this is too much time, push for an earlier appointment. Best wishes.
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1790532_tn?1329317106
Hi everyone

All has gone on since I last emaailed on this site!  I have had bilateral MRI's which show 2 tumour that are invasive ductal carcinoma, the third tumour is not a tumour, but fibrous tissue.  The MRI doesn't show any lymph vascular involvement.  I will be going into day surgery next tuesday for sentinel node disecction to see if that is true.  

Then there is the problems with the calcifications as the radiologist does believe that they ard DCIS, but if a wide excision lumpectomy wa done, I would need to go back and have a sterostatic biopsy done which will delay my time even more, waiting again for pathology reports.  

My surgeon said we could skip the biopsies and go for a wide excision lumpectomy with oncoplasty, but then if the he sent the specimen in and the margin weren't clean, then it would require additional surgery again.
Because so much tissue is coming out, he said a mascetomy would also be a good way to go with immediate reconstruction. That way, one surgery.
So I will get a mascetomy with immediate reconstruction.  I surgery date foor that is either October 20th or 27th,  I have yet to see the plastic surgeon.

I originally was diagnosed with this on August 12, 2011, so some time has elasped.

I aso found out that I am triple negative for hormones.  Do you know what treatment is out there post surgery.

I am also thinking of trams flap reconstruction.  Will that interefere with radiation.  I might not have to get chemo if my tumours are under 2 cm, but if they end up being attached and are over 2 cm, then chemo it is.

Anyhoo, thats it in a nutshell! going for Ct of chest, abdomen and pelvis tomorrow, pre-op for sentinel node dissection Friday, dye injection on Monday and tuesday the day surgery.  I never realized how many appointments there were.

Thanks
Kindly
Diana
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739091_tn?1300669627
Hello Diana,

I'm so glad you had those tests done. You know more than you started with and it sounds as if you are comfortable with your decision. You mention your cancer was diagnosed as triple negative. This type of cancer can be more difficult. Your treatment will most likely be chemo, radiation and herceptin. I would have recommended mastectomy had you asked.

Are you in Turkey?

You specifically asked if Tram Flap is a good choice should you need radiation. Tram Flap is a tissue transfer reconstructive type surgery, albeit an older type that does have some drawbacks. Tissue type reconstruction is the best way to go if you're going to have radiation therapy. They take your "six pack" stomach muscles and tunnel them up under your skin to act as support for your new reconstructed breasts. However, those muscles are really needed where they are right now, supporting your body in almost every facet of movement. Once they cut them, they insert a mesh type device to "hold" everything in place. People who have had Tram Flap surgeries tend to have a much higher incidence of hernia's and other complications. Please research tram flap surgery and complications. I asked if you are in Turkey because if so I don't know if they do DIEP flap reconstruction. One other thing... if you're going to have this surgery done, I'm going to strongly suggest that you have both breasts removed and reconstructed at the same time thereby reducing your risk tremendously. Also, here is a link about different reconstruction options available in our world today.

God Bless you in whatever decisions you make.

http://www.medhelp.org/posts/Breast-Cancer/Trans-flap-vs-implants/show/1308880?personal_page_id=384050  ;(Copy and paste that link to your computer to read about them.)
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1790532_tn?1329317106
Hi Sue!

Thanks for your reply!  First of all, I don't live in Turkey, I live in BC, Canada.
You are probably right about not touching my stomach muscles as a couple of years back, my disc shattered in my back.  I need those stomach muscles for that very reason, plus I do have MS which weakens my muscoskeletal structure anyways. I don't want mesh or anything else in my stomach.
I asked my surgeon about removing the other breast, and he said no!  He said there is nothing wrong with it.
He said i could have the chest expanders and still have radiation as the permanent implant won't be inserted until after the radiation is complete.
But, I am not liking the fact of implants and having to have them replace further on down the road.
I turned 57 in July and already had one cancer, a rare form called carcinoid(a neuroendocrine tumour) found in my terminal ileum (small bowel)  I had that resected almost 6 years ago.  I still see an oncologist for that as they keep a close eye on finding another tumour elsewhere,
I am hoping for a good cosmetic outcome for my one breast and hopefully I will get symmetry with the other remaining breast.
Originally, my surgeon was going to do that wide excision with oncoplasty, but I ahve seen photos of those and they don't look good.
Can a plastic surgeon do a Dieo flap when I have 2 cesearian scars, not from having babies, one was from having a hysterrectomy and the other my bowel surgery.

Thanks Sue!

Diana
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962875_tn?1314213636
Hi again,

Women who have been diagnosed with BC  (or are just at high risk due to BRCA gene mutation) in some cases request bilateral mastectomy as a prophylactic measure, so I don't believe your surgeon's refusal "because there's nothing wrong with it," should necessarily be the final word on the subject...

Also, skin that has been irradiated can become more fragile, and may not do well with expanders. (One of our members had an expander break though the skin, and had to have it removed and wait forthe skin to heal.)

I wonder if you might want a 2nd opinion surgery consult?

Regards,
bluebutterfly

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739091_tn?1300669627
Diana,
I'm sending you a private message so look for it in your inbox above.
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739091_tn?1300669627
bluebutterfly2222 is correct... you have the option to get both done at once and he can't tell you otherwise. If a doctor isn't listening to your needs then it's really best to find another.

I had DIEP done and I also had a cesarian section. My scar from that surgery is gone now and so was the slight overhang they gave me when they sewed it back up. I am 56 yrs old and have a flat stomach. Though that is a benefit of my reconstruction, I have to say it's not why I chose it. I had 8 weeks of daily radiation including 7 days of boost. I don't care what they tell you about expanders not being affected, that's purely not right in MOST cases. There is a 70 to 90% failure rate because once the skin has been radiated, it no longer stretches. And it's thin to begin with so ... this doctor is telling you something that just isn't in your best interest. Please seek a second and third opinion. I'm not telling you to do that to find a YES man... I'm telling you to do that because I want you to find a doctor that puts your health first.

Best wishes to you :)
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1790532_tn?1329317106
Hi! Sue and bluebutterfly

I have yet an appointment with my plastic surgeon.  I will know on Monday when that appointment will be.  Pretty soon, I imagine as my scheduled Mastectomy is for October 20 or 27.

I do like my surgeon.  He comes highly qualified and as does the plastic surgeon that works with him.  I do want a Diep flap procedure done.  To me I think that is the best personal choic I will make as I need my stomach muscles to hold my back up and I am a golf player to boot.

My surgeon did mention Tram flap, but I never did tell him about my shaterred disc in 2007.  I just forgot to mention it!

My cesarian scar is rather ropey and feels like a steel rod in there.  I do have an overhang and even when my stomach was flat, I still had that little sausage thing hanging over the incision.  

My oncologist for my other cancer, the carcinoid doesn't want me to delay surgery any longer.  I was diagnosed August 12.   I did have another consult with another surgeon, but that would have been next week and then i would have to wait even longer for surgery.  As it is, I ahve the sentinel node dissection on Tuesday, the day i would ahve see the other surgeon.

My carcinoid tumour in my small bowel was only 1.5 cm but had alread metastasied to my lymph nodes.  My mitotic rate, KI 67 was a 4, but my grade was a 2/3.  I get checked every 3 months for tumour markers, plus get yearly scans.

My surgeon did test these breast tumours for carcinoid, but they were negative and are Invasive ductal carcinoma, grade 3, triple negative.  I will know the stage soon.

Can you tell me how your stomach felt after the tummy tuck.  if they don't cut into the muscle, i would think that it would be less painful.  I know that both my hysterrectomy and bowel surgery were extremely painful because of muscles being cut!

Anyhoo, I feel nervous having a second cancer, especially an agressive one.

Thanks for your input ladies!  i appreciate you so much

Diana
MS diagnosed in 1994
Carcinoid (neuroendocrine tumour) resected 2005
Invasive Ductal carcinoma of left breast August 2011
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739091_tn?1300669627
Diana,
Keep that second appointment. I guess I should mention that there are very few surgeons who do DIEP flap reconstruction. Look for the book The Breast Reconstruction Guidebook by Kathy Steligo for references for physicians. You can also post a question at facingourrisk . org about doctors that do DIEP in your area and you will find one I'm sure. You have enough time to get the PS you want for the surgery you want. It's been two weeks since you made your post here so you have time. You do, ok? :)

I never really had pain with my DIEP at the donor site since it was numb but I had extreme tightness and that took some getting used to. I was up and walking the day after surgery. I slept in a recliner chair for a couple of weeks because for me that was the most comfortable way to sleep.
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739091_tn?1300669627
Diana,
Did you see the response you got from Dr. D?
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1790532_tn?1329317106
Hi Sue and everyone

Well, I ended up a double mastectomy with immediate reconstruction on October 20th.  My plastic surgeon used Alloderm with implants.  My new additions look fairly good!  Post complications involved very painful fluid build up in my left lung!  Otherwise, 4 chest drains are out and i see my plastic surgeon post-operatively tomorrow.
My pathology report says I am triple negative.  My tumor ended up being one tumour at 1.7 cm with nothing to nodes.  I ahd sentinel node biopsy done.  As well as the invasive ductal carcinoma, grade 3, I also had DCIS, grade 3.  Now, do I still need chemo.    Seiing the oncologist on November 14th?  Hope you are well!  My email address is changed from deedum@telus to ***@****
KIndly
Diana
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739091_tn?1300669627
Congratulations! I know that wasn't an easy surgery but I'm thankful you're doing well and are on the other side.

Triple neg? You'll be doing radiation too Diana?

I hope you like your new "girls" when everything has calmed down. :)
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1790532_tn?1329317106
Hi Sue!

I don't know if I will be doing radiation as well.  If I wide excision lumpectomy, maybe radiation would be in order, but i know for sure chemo will be done!  There doesn't seem to be that many woman who are triple negative at my age which is 57?  Plus there are no hormone therapies out there for us triples.  So far, CT of chest ,abdomen and pelvis show no metastasis!  I guess time will tell, but I am feeling positive.  Right now I am getting "ZAP" like sensation in both breasts!  OUCH!
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