Decision: WLE or remodeling and reduction?

Hi ladies. As I have ILC they’re finding it difficult to estimate the size, 2 or 3cm. They’ve spoken to me about having a WLE but with proviso that if the margins are not clear the next stage might have to be MX. The other option is to take out a larger area (30%), remodel the breast and reduce the other healthy breast to match. I’m a 34FF so I have tissue to spare. My oncoplasty surgeon (one of the best in the country) says that in her experience lobular cancer tends to be larger rather than smaller and I think she probably feels the safer option is go for the more extensive surgery and all its drawbacks, recovery time, smaller boobs, scaring and loss of sensation, potential healing problems etc. But the choice is mine! Both are ‘approved’ ways of dealing with this type of cancer and the final biopsy may find it was only be a small 2cm and I’ll have ended up with having unnecessary surgery. I do however dread MX and the thought of reconstruction flaps etc. I’m 53 and single so still want to feel normal and attractive at the end of all this. Any thoughts or advice?

Hello fingersx (great name by the way),

Sorry that you had to join our club, but I’m glad that you’ve found your way here.

You say that you dread the thought of the mx/reconstruction route, so perhaps WLE is the way to go for you. If you are fortunate, there may be no need for further surgery. If the mx/reconstruction route proves unavoidable after the WLE, then hopefully you would be more accepting of the necessity for the procedure. Whilst having to schedule two operations and manage two recovery periods isn’t easy, it may be the better decision for your emotionally.

I can’t speak from personal experience, I’m afraid, but wish you the best.

Debs x

Hi Fingersx

Don’t know if it’s relevant to your situation, but in July I had surgery for invasive ductal BC which was planned for a 2cm tumour, which turned out to be 3cm (at about 12 o’clock above my nipple) and I’m about the same age as you (I’m 51). I had the tumour removed as a WLE with breast re-shaping using my remaining breast tissue. Therefore effectively a breast reduction and lift, with the reduction necessary because of the volume of tumour being removed. This was possible because, like you I had tissue to spare, or thought I had, since I was a 40 DD. This was done only on the breast with cancer. My surgeon advised that it was better to wait until that breast had settled down after radiotherapy to see what shrinkage, if any, affected it, then the 2nd breast could be matched to the 1st. She anticipated 1 or 2 cup sizes difference between them after the initial surgery. I could see the logic in what she advised, and still can. The breast which has been operated on looks surprisingly good, typical breast lift type keyhole scar around the nipple and a straight line down from that to join another along the fold under the breast, no scar across the top of the breast, a nice shape although with a bit of a dent towards the armpit, and I’m pleased with it.

However, what I hadn’t anticipated was how upset I am by being left with a very mismatched pair of boobs. Because the tumour turned out larger than expected I’m more like 3 cup sizes different, now approx an A or B on one side and still DD on the other, and I’m terribly conscious of it. I was intending to return to work after the radiotherapy effects settle down, but now I can’t face it while I feel so lob-sided and am trying to organize surgery on the other side to get it to match ASAP. The obvious answer appears to be bras and foam pads, but because the breast with the cancer has been lifted the nipple is two inches higher than the other one which has the natural droop of a 51 year old DD cup. I’ve now also been told by the radiotherapists at Christie Hospital that the radiotherapy shrinkage could occur over many years so waiting a few months is not going to improve the matching pair.

So my advice would be to go for having both breasts done at the same time, go for the 30% reduction – at our age they’re only going to be heading South anyway – and get all the pain over and done with in one go. Doing it in two stages just means that I’ve got to go through it all twice.

Sorry to ramble on at such length but hope it helps!

Sarah x

Hello Fingersx,

Lkke you I was 53 and single but with invasive ductal. My surgeon performed the wle and reduction at the same time. I was given all the warnings about the risks that you state and it was quite scary to think about what might happen. However, it was perfect. I hardly had any pain or discomfort and everything was intact and healed within a couple of months. Brill surgeon. I just wish I had asked to have more removed! I was warned that the none rads side would start to drop a little and I think I can see that happening, but all in all it was a good decision. I am 15 months on from surgery and 8 months on from chemo and rads and just beginning to feel increasingly "normal.

I googled “therapeutic mammoplasty”

Good luck with whatever you choose.

Sheila

Hi Ladies

Thank you soooo much for your thoughts and advice. As you’ve no doubt realised, it REALLY does help to share experiences and I now feel so much more confident about my decision - to go for the bigger op with remodelling and reduction to both breasts all in one go.

Thanks Debs for your welcome and thoughts - all good to put into the mixing pot.

Sarah, so sorry to hear your story and how you now feel a bit mismatched but this really rang bells with me and is a good example of why a simple WLE on one breast is perhaps not right for me - so thanks so much for the all the info - not rambling at all - really very helpful. I hope they get you on a fast track to get the other one done soonest.

Sheila, good to hear the pain and recovery wasn’t as bad as expected. I’m a bit of a wimp with pain and although friends and family will rally around, I live on my own so want to feel 'in control’again as soon as I can. I’ve been told I should be able to gently do most things myself (self-caring is the term they used)within a day or so out of hospital, although driving may take 2-3 weeks. Is this your experience? Funny how they always go on about not doing the housework - I always do as little as possible anyway to this is the perfect excuse!

All the best to you all and thanks again for the support.

Mary x

Hi

Hi

Hi Mary, I live alone too, although my sister stayed with me for a couple of days. I was really able to look after myself very quickly, and I do like to be independant! … but was careful not to stretch and lift things. It was a good way of explaining away the lack of dusting!!! It was prob about 3 weeks before I drove.

I’m so glad the info is helping you to make your decision. I remember feeling it was such a big step, but looking back after a year, it feels almost routine!

Good luck and let us know how it goes.

Sheila xxxx

Hi Sheila
Glad to hear the info helped and thanks in return for your supportive comments. I’ve been hassling everyone I can think of and have now got agreement to get the other boob done as soon as the immediate RT side effects calm down.
I agree with what Sheila said about being able to do things at home within a few days, and I started driving again after 2 weeks, but that was VERY sore (I needed to drive ASAP because I live in a very isolated spot). I found that the key to comfortable driving was to install a clip on the seatbelt so it wasn’t under tension where it crossed the operation wounds, but would still work if I had to stop suddenly. That made such a difference.
The other main thing was to find a really comfortable bra that sits softly on the scars that go under your breast when you’ve had a reduction & lift type operation. Many people suggest sports bras, but I found those were much too firm and therefore painful. I ended up with a padded nursing bra on the recommendation of the bra fitter in John Lewis. Not cheap at £29 but worth it.
Good luck
Sarah x

P.S. Finger trouble! Sorry, should have said Hi to Mary, not Sheila, although we’re all included in this conversation!