surgery after chemo

[dammie]

I had a lumpectomy and axil lymph node disection on 9/15/03 for IDC with 1 of 22 pos. nodes.  I am on dose dense chemo- completed 4 cycles of AC and 3 cycles of taxol.  My last taxol is 2/19/04.  I have decided against going for radiation as originally planned and decided on a bilateral mastectomy instead - right side for treatment, left side for prevention.  My surgery is scheduled for 3/17/04.  Is that enough time after chemo to safely have a mastectomy with reconstruction without the complication of infection?  Surgeon says that one month is enough time, however, it will depend on my blood counts.  I am also wondering if I should even continue with the last dose of taxol due to the side effects I have been having - severe bone and joint pain.  I know that these pains are to be expected but I am wondering if this is a sign of possible permanent damage since the pain has been debilitating and getting worse with every treatment. Could this be the case?
     Also, I have a planned trip coming up in April, which would be one month after the mastectomy and started reconstruction.  Is it safe to be in a plane and go into  pools and the ocean so soon after surgery?  I need the trip for my mental health but I do not want to jeopardize my physical health and put me at any risk.  I appreciate your advice and want to thank you for a wonderful service that this site provides to cancer patients and their families.

[dammie]

Dear Rickndee,  I don't professionally know the answer to that question since I am not a doctor.  I can tell you that in my personal experience with chemo, I have not had my lymph nodes affected by chemo.  Sorry I could not be of more help.  Try asking this site in a brand new posting.  They are wonderful in answering (usually within a day) and hopefully can provide you with the information you need.  Good luck!!!

[rickndee]

Dear Dammie,
since you've had chemo, did you experience or hear at all the other lymph nodes, normal or malignant could be affected; i.e., become temporarily swollen because of the strength and type of chemo?
It seems logical that could happen, but of course would like to know if that is the facts.  Am contacting my doctor today regarding this, but may be awhile before i get that information.  thanks.  Dee

[Rosa]

I had bilateral mastectomy 12/9/03 after a recurrence.  I opted for expanders to be followed by permanent implants of silicone.  
My left breast was radiated 3 1/2 yrs. ago at which time I only had a lumpectomy with lymph node dissection.  I was concerned after all I had read that the radiated side would not stretch enough to produce bilateral symmetry.  I am finding that although I must receive the saline injections more slowly on the radiated side, it isn't much different - just may take more time. Also, and this is important, at the time the implants will be placed, some of the scar tissue can be removed, enabling a more cosmetically appealing result.

I am a thin person so to have a bilateral tram flap was out of the question.  It is a longer recovery time than with expanders, and I don't like the fact that the abdominal muscle is cut and I definitely didn't need a tummy tuck - lol.

Good luck with whatever you decide,  Rose

[pitcrew]

My plastic surgeon thought going with implants in my case would produce better results. Also I wasn't really thrilled about the recovery time involved with flaps. I haven't made the decision yet on which surgery to do on the right breast. I am however going to do either a mastecomy or sub q mastecomy. My cancer wasn't found by mammogram either, so my trust level isn't real high and the thought of it missing it in the other breast is not acceptable.  Good Luck to you.

[dammie]

I am having the same surgery as you:  tissue expanders with implants.  What made you decide on implants vs. tissue from other sites?  My doctors also said that there was a small  percentage of an increase for survival with dose dense but I took every extra point that I could get. Good luck with the surgery.

[dammie]

Dear Rizzo,  I seem to have the same concerns as you.  My tumor was 1.6cm IDC and LCIS was also found.  I originally agreed with my surgeon for lumpectomy and radiation (he said it was as successful as mastectomy).  Since going through chemo I have had second thoughts about ever taking a chance of going through this again so I met with a plastic surgeon to discuss options.  He told me that a radiated breast was not a candidate for implant reconstruction due to the changes in the tissue thus making expansion a problem. Since I am not interested in any other type of reconstruction if ever needed in the future, this poses a real problem.  As per my doctors I am considered high risk for a "new" breast cancer:  I am 42 with a family history of breast cancer(mom died aat 49, maternal aunt died at 42).  Doctor said that LCIS found could be a marker for possible future breast cancer in either breast.  My original cancer was not seen on mammo or sono (it was self detected) due to very dense breasts making early detection more difficult.  I was, however, neg for BRCA1 & BRCA2 but the genetic doctor still felt that there was a genetic problem and that it was very possible that I was in the small percentage of women that the gene does not show up or I possibly have a gene that has not yet been discovered.  This genetic doctor also feels that I am high risk.  My oncologist strongly recommends a bilateral mastectomy, my surgeon agrees with my decision but still feels that the original plan including radiation would be successful at this point. I am afraid to take a chance.  The  stress of this experience has reached a peak and I feel that recurrence is enough to deal with let alone having to deal with a brand new breast cancer again.  It ia a very personal and difficult decision that I am sure you understand.  In addition to your concerns of radiation, I think you are right about peace of mind.  How have your doctors advised you?  Keep in touch.

[lizziecee]

I would be interested in hearing why mastectomies are thought to preclude recurrence of breast cancer in the US. I have just seen my surgeon for a 3 month check up after surgeries, chemo, radiation and tamoxifen (he switched me to Arimidex last week). Because my tumour was not palpable I am concerned about recurrence, especially as they only do mammos every 2 yrs in England, after the baseline mammo at one year after surgery.
My surgeon said that even after a mastectomy, the cancer can return in the affected breast, or in the other one. I had 3 nodes out of 18 cancerous and am obviously concerned that the cancer may return, even though I have done all the adjuvant therapy prescribed.

[dammie]

My doctors told me that mastectomy would leave only a 2% percent chance of a new cancer developing on the operative side.

[pitcrew]

what kind of reconstruction are you going to have? I am scheduled to start reconstruction march 3, tissue expander then implants. I am also considering having my right breast removed for both peace of mind and since they have to implant that side anyway (make them match) I had the same treatments but skipped the taxol because of side effects. Doctors told me considering dose dense the percent survival rate should only drop by a percent or 2.. but then as you know "Everyone is different"

[rizzo]

i am in the same situation as you.  i finished my chemo on
1/27/04 (same treatment as you)  i also have 1 node pos. my
tumor was 2 cm.  i am strongly considering mastectomy, due
primarily to side effects of radiation and hopefully more peace
of mind.  what are your reasons for having mastectomy and what
does your surgeon recommend?? my surgeon keeps telling me that
it is the same, but i always have doubts.  would love to hear
from you.

[surgeon]

I'll comment on the surgical parts of your question: I agree that a month would typically be enough time, and that it will depend on your blood counts. If they, particularly the white counts, remain low, the surgery might need to be deferred. As to swimming, etc, a month after: in general it ought to be ok, unless there are healing problems. With mastectomy, even not having had recent chemo, sometimes the edges of the wound are slow to heal, and if that happened it might be that the surgeon would want you not to go into a pool. Flying would be ok no matter what. Since some issues depend on the exact nature of the planned surgery, you need to direct these very good questions to your surgeon, as well.

[CCF-RN,MSN-rf]

Dear dammie:  You should complete the taxol.  Bone and joint pain that is transient (though it can be severe) is not usually a reason to stop therapy.  Surgery after chemotherapy may happen withing a month - provided your blood counts have normalized.  This is really the key - more than the actual time.  Even with normal counts, post operative infection is a risk of any surgery.  Regarding travel, this is a decision that should be left to your surgeon.  Four to six weeks after surgery (without any complications) is often standard for return to work and normal activities.  One caution, since you plan to fly, you might want to invest in a compression sleeve to wear on the arm that received the lymph node dissection.  There is a risk, with pressurization, of inducing lymphedema.  You can minimize this risk by taking precaution.  This is a lifelong possibility and wearing a compression sleeve may reduce the risk.