Surgery options for breast cancer


I' ve been diagnosed with IDC with multifocal leisions (2). I had a sentinel node biopsy which was positive for 1 in 5 nodes. I am 40 years old, married and have 2 children aged 8 and 5. I have started neoadjuvant chemotherapy and have been given 4 cycles of FEC and so far 2 cycles of TAxol out of a total of 12 planned. An interim ultrasound shows the reduction in size of both the lisions by half - they are now 6mm and 3mm.

The surgery is planned for June after the last chemo cycle. This is to be a mastectomy as per the assessment of my breast surgeon. No lymph node removal has been recommended.

I want to find out the reconstruction options that are best suited for me. Would delayed reconstruction be a good option for me? Are there any support groups for the year's wait with one breast?

The reconstruction options under discussion are:

1. Saline/silicon implant - but does this get impacted by the fact that I need radiotherapy too.

2. Abdominal flap method - this I'm told has the best results in terms of healing of both the sites. But some abdominal fat is necessary to be eligible for this method.

3 Dorsal flap method - which may impact mobility to some extent in some cases.

Which methods are most frequently followed in treatment in Bangalore/Mumbai? And which would be most free of complications long and short term?

Confused cancer patient.

6 Replies

  • Reconstruction is a very individualized treatment. It varies from person to person and doctor to doctor. There can not be one single guideline as to what is best. Some doctors will be good at flaps while some will be good in implants. The factors to consider during reconstruction are volume of opposite breast, nature, fall, future radiation treatment etc.

    As for my team, I do not delve into reconstruction at all. I straight away refer to my cosmetic surgeon colleagues who have plethora of options and decide what is best for my patient and then do it. Sometimes during primary surgery, sometimes as a secondary reconstruction.

    So I will not be able to answer your queries. I would suggest you meet a cosmetic surgeon and try to understand from him / her as to what is best suited for you. You could also go for a second opinion in case of any doubts.

  • Thank you, Dr. Shah. I will meet with a cosmetic surgeon and get their opinion on what kind of reconstruction i am suitable for. 

  • Hi There and good luck, I had a bilateral mastectomy and because 1 positive lymph node, sentinel, removed all. anyhow I had  reconstruction. I have silicone implants and love them. Surgery was easy, not hard to heal from. At the time my youngest child was 3. Now shes 6. life gets better with time! Take Care

  • Thanks for your response, Sabrina4. I'm glad it all got better. Very encouraging to hear. I'll consider silicon too. Though I'll probably need radiotherapy in which case silicon will have to be postponed to next year. But great input from you. Most helpful. Good luck to you too!

  • Silicone implants tend to shrink and change shape during radiation and they are better done after radiation is over. Free flaps or DIEP can be done prior to radiation as they can tolerate it. 

  • Thanks, Dr. Shah. And now to find out if I am eligible for free flap or diep.

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