LCIS at 45, prophylactic mastectomy definition?

[Fuzzz]

If one opts for PBM for a diagnosis of LCIS at 45, would skin/nipples be spared?  On another forum, people were talking about expanders, so it sounds like skin was removed.  They had not had radiation or usually a more advanced diagnosis than LCIS.  I was hoping that if all I have is LCIS, the surgeon could spare skin and nipples?  

I asked this already on the expert site for reconstructive surgery, but have not received a reply.

[loracc]

I'm perplexed as to why you're thinking of having a prophylactic mastectomy for LCIS.  It is an indication that you are at risk for breast cancer.  That doesn't mean you're destined to get it.  
I was diagnosed with LCIS almost twenty years ago.  I go for regular check-ups and changed my lifestyle to minimize risk for breast cancer.  So far, so good.  

[ojmoves]

Hello all.
i too was recently diagnosed with LCIS. Am 46 y.o., no family hx of breast cxr, breast-fed 2 children for 2 years each (and I thought/understood THAT would prevent any breast cancers/issues in future...hmmm..) and am also now worried since we have to switch over to new health insurance plan and I was denied coverage for 2 years! Have followup mammo this week post biopsy surgeries.  I am beside myself..dont yet know what to do, which way to go...except find a f/t job and join group plan...I think...Not less important, I wanted to ask LORACC- what did you change in your 'lifestyle to minimize risk for breast cancer"? I am VERY interested in other ways to deal with this. Tamoxifen was also recommended though I have hesitated yet to start it. I would appreciate any info/websites of medical/other professional references  you may have to above issues, MAny thanks,
Oj

[Archibald S Miller III, MD,FACS]

You have a good surgeon who has been on the advancing edge of reconstructive surgery. However, you must understand that not all breast cancer spreads just to the tissue next to it. It can go to bone, lung, liver and intestines, so even if it does not spread locally, it can still spread elsewhere. In fact, MOST breast cancer spreads to areas distant from the original cancer.

                              arch miller

[outnumbered]

I am 40 and had DCIS with focal invasion (stage 1-no nodes).  I am also BRCA1 positive so the obvious choice was a bilateral mastectomy.  I DID have nipple/skin sparing surgery in August.  My surgeon is one of the pioneers in this type of surgery.  He did advise me there was a slight risk of recurrence in the nipple since it IS breat tissue, but even if it did, it would remain local because there is no tissue for it to spread to.  In the case of a recurrence in the nipple or areola, the tissue would just be removed.  So far I am really pleased, however I still have my expanders in so it is difficult to tell how they will really look.  I am scheduled for my exchange surgery in a few weeks.  If you do opt for the sparing surgery, please be sure that your surgeon has a lot of experience in this.   I have heard stories from patients where it was not successful.  

Although our dx is a little different, I hope I have been helpful.

After many opinions (2 tumor boards from top NYC cancer centers) I am considered to be cancer free and I do not require chemo or radiation.  

Best wishes!!!!!

[Archibald S Miller III, MD,FACS]

All good advice. Good luck,

               arch s miller ms md facs

[Fuzzz]

Thank you.  

In fact I had to see my general surgeon yesterday because I thought I had a wound infection (wrong), and he told me which plastic surgeon he'd send his wife to for this.  I went to that surgeon's website and saw that I could get prosthetics with a more natural shape rather than the round shape that the 20-somethings usually get, and that I could wait up to 3 years to go ahead with it.  That's all very encouraging.   Since I don't plan to go up in size or make a big shape change, I'm hoping I won't even need expanders, but we shall see when I see the plastic surgeon down the road.  The whole idea is to avoid radiation and chemo, so I won't have to deal with radiation complications.  

[Archibald S Miller III, MD,FACS]

If one does a prophylacticmastectomy, the areola can be spared. However, it is recommended that the nipple itself be taken because it does contain ductile elements. Very aggressive new doctors can be found who will perform these procedures. The most common approach is to take both areola and nipple. The tissue expander is used actually to stretch the muscle and skin and give a new shape to both, and is then followed by palcement of a permanent prosthesis. Radiation precludes the use of tissue expanders in most peoples hands.  I hope this answers your questions, respectfully,

                    arch s miller ms md facs