Treatment after Surgery

I had a lumpectomy last week where an infiltrating poorly differentiated ductal carcinoma, Grade III (Bloom-Richardson score=8) was removed.  It was in situ and 0.9 cm.  No angiolympahatic invasion was identified and 11 lymph nodes were removed with benign reactive changes and no evidence of matastatic tumor.  Originally the surgeon said he would recommend radiation only, but now he's leaning toward radiation and chemo.  With no cancer in the lymph nodes, why would chemo be necessary?  Also, I've been told by a cancer patient, that if the cancer reoccurs and a mastectomy has to be performed, I will not be able to have reconstructive surgery because the radiation treatments will not allow the skin to stretch.  Is this true?  Thank you for your guidance.

[CCF-RN,MSN-JS]

Dear Chatch, Over the past decade there has been more information that more clearly defines the subpopulations of women with localized breast cancer, for whom adjuvant chemotherapy is indicated as a standard component of 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.  Chemotherapy has been shown to substantially improve the long-term, relapse free, and overall survival in both pre menopausal and post menopausal women up to age 70 years with node-positive and node-negative disease.   Investigation continues as to whether there are specific patient populations for whom it is reasonable to avoid the administration of chemotherapy.  Unfortunately, very limited information is available to answer this important question.  On the basis of available data, it is accepted practice to offer cytotoxic chemotherapy to most women with primary cancers larger than 1cm in diameter (both node-negative and node-positive).  As in your situation with node-negative cancer less than 1 cm the decision to consider chemotherapy is individualized, based characteristics of the tumor, menopausal status, age, and general health.  This information is from the National Institute of Health Consensus Statement on Adjuvant Therapy for Breast Cancer compiled in December, 2000.
In women who have had prior radiation and may need reconstructive breast surgery in the future, there are types of reconstruction that can be done such as TRAM flap, or lattisimus flap which are procedures using the women