Having Radiotherapy or not, following mastectomy? Help!

Hi. I cannot decide whether to have RT or not. It’s not just about the cosmetic outcome, it’s also the recurrence risk/benefit aspect and getting back to normal life asap after 4 months off sick already. 

When I use NHS Predict, it only asks how big was ’ the tumour’. It doesnt ask how many there were, plus the result makes no mention as to the prognosis with or without RT. It only mentions chemo and hormone therapy. So I can’t even use a prediction tool to help with my decision.


I am 49. I have just had skin sparing mastectomy to left breast, with temporary spacer (implant) fitted under the skin, due to be removed in 2 weeks and replaced with permanent implant recon, under the muscle. My DX was a ‘grey area’ as to whether RT is needed. Surgeon and oncologist recommend it, but there is higher risk of skin shrinkage/tightening, potentially distorting the implant, meaning it may need to be removed and have full mastectomy, leaving only option of LD Flap or staying flat, both of which horrify me. Normally, they like to remove the spacer and do a full mastectomy before doing the RT. But i have asked them to do the recon anyway and I now have to consider whether to go ahead with RT, knowing the risks. It was horrific enough having to cope with the DX and mastectomy. I still havent come to terms with all of this. 


My cancer was Grade 2, Stage 1 ILC. There were 3 tiny areas, the largest was only 6.5mm, also with a small cluster of tiny dots too small to measure (the pathology report doesn’t say how many ‘dots’ there were - it just says ‘numerous other smaller foci in the upper medial breast…at about 10 o’clock…’ - but somehow the surgeon plucked a figure of  ‘about a dozen’ out of thin air, even though she admits it doesnt specify the number or how far apart they were). In addition was a micromet of 0.9mm in the sentinal node only. As it was mult-centric i had the mastectomy. They arent actually worried about the tiny node involvement, but due to the number of small sites they want me to have RT. I did have a 2cm ducto-lobular tumour in the other breast 7 years ago, followed by RT and Tamoxifen and it’s my history that is really pushing their decision to treat the skin and chest wall this time, even though there were good margins (no tissue left to remove), the pathology report states ‘no vascular/lymphatic invasion’ and Stage 1 cancers dont normally need RT.  


No-one is saying they believe any cancer remains. It is all just a belt and braces decision. I am fighting against having RT. 



I would welcome any advice please. 

It’s a difficult decision for you. I have read posts from other ladies that had implant reconstruction and then had rads. on here and we’re ok.
I have had a full MX no recon. I was not expecting to have rads. But because I had 2 small tumors and a large area of idcs the margins were only 0.3mm on the idcs so rads recomended as well as chemo herceptin and tamoxifen.
As far as I understand with nhs predict, it is taken that you have had surgery and rads so not mentioned with treatments. I had 2 tumors . One was 8mm grade 2 and the other 12mm grade 3 in one quadrant of breast. My oncologist put it into predict adding them together as a 20mm tumor grade 3. I think it gives you a very rough idea as it’s not exactly personal to you and not all your details can be added.
I Realy feel for you having to make this decision. But find out as much as you can before you do.
Take care