QuestionHi, I recently have been diagnosed with DCIS and .5cm of invasive cancer. The cancer area has been removed. I've had a sentinel node biopsy and a full nipple removal, both benign. I just had another biopsy in another part of my same breast, the results are Atypical Lobular Hyperplasia. I'm overwhelmed with my next course of action...do I just have radiation, and take Tamoxifen, watch and see? Remove more tissue around the recent biopsied area then do radiation? Or have a mastectomy, then reconstructive surgery later? I was told that a radiated breast is more challenging to reconstruct?? Any input would be so appreciated!! Thank you
AnswerJennifer,
I'm sorry you have to go through all this.
You could have radiation to the remaining breast - this will decrease your risk of the invasive breast cancer coming back. Radiation therapy typically leads to further changes in your breast. Your breast will likely become smaller and more firm. The skin over that side of the chest may also change texture and have some color changes. These tend to improve over time, but in many instances, there are permanent changes to the remaining breast and chest tissues. You will also be exposed to the risk of radiation damage to deeper tissues including the lung on that side and your heart (if it's your left breast). Radiation does allow you to keep the remaining "natural breast" but to be honest, some women feel that what they're left with is so different to the other breast (and what they started with) that it was "not worth saving", especially in women who were small breasted to begin with.
In my experience, the ideal candidate for breast conservation (lumpectomy and radiation) is a women who is larger breasted. The change in overall overall breast size and breast symmetry are far less noticeable in these women and the cosmetic results can be very good.
This does not fully address the ALH. ALH is not cancer but it is associated with an increased risk of breast cancer in the remaining breast(s).
Mastectomy would decrease your risk of cancer recurrence, remove the risk from the ALH and take away the need for radiation. Breast reconstruction could be performed at the same time. This is in fact preferable in your case and is what I'd recommend if you go with the mastectomy option. Immediate breast reconstruction leads to much better results than delayed reconstruction:
http://www.prma-enhance.com/index.cfm/ProcedureNameID/19/PageID/1946
Reconstruction in no way affects your risk of future breast cancer and is now considered standard care for women with early breast cancer (stage 1 or 2). Since you were diagnosed with early breast cancer, you are certainly a candidate for this (if you are relatively fit and healthy otherwise).
To take things a step further, any "lobular" pathology generally increases your future cancer risk in the other breast also. The ALH, together with your recent cancer diagnosis, makes you a candidate for a prophylactic mastectomy on the other side which insurance should cover. In this instance you could have a bilateral mastectomy and immediate bilateral reconstruction. Once again, this would take away any need for radiation but would also minimize your future cancer risk as much as possible.
If you think you would consider mastectomy and reconstruction it would be best to avoid radiation altogether - you are right; it terms of the reconstruction, it certainly makes things more complicated and also (typically) significantly impacts the final cosmetic result. More importantly, you'd also avoid the potential risks I mentioned.
Lots to think about. Much of this probably seems very drastic but the timing of your question is very good. Now is the time to think about these things and decide what's best for you.
Dr C
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