Mastectomy or chemo, which first? Advice please

Hi there everyone
i would very much welcome your advice. I had stage 1 grade 3 IDC with DCIS last year in left breast 28 mm lump, WLE and SNB, no node imvolvement, followed by 6 x FEC and radiotherapy which finished end of Feb. Found new lump in other breast In March. This time had WLE and SNB, no nodes involved but positive vascular invasion, HER2 negative and only 2 out of 8 ER and PR, so been termed almost triple negative. removed 30mm IDC 31 May, but close to margins so had an anterior shave which residual IDC, grade 3 1.55 from lateral margin, and 25mm. So, have been told I must have mastecomy, but can choose whether to have chemo before surgery, this time taxotere likely. Also told will have radiotherapy and so a recon can only take place 6 months after end of radio. A that time, they would also remove my left breast with immediate recon, if I wish, given already had cancer there. Aside from being one breasted for a shorter period if I do chemo first, which appeals because I am finding it hard to come to terms with, do you have any thoughts and experiences which may help me decide please? I see the oncologist to discuss and decide on Monday and they will keep surgery slot currently scheduled for 5th Aug open till Tuesday, so they can offer to someone else, which I understand. I hope to hear from you and wish you all the best.
many thanks

I had the chemo before surgery because it was recommended for me. One advantage is that you get through the worst treatment first. After you’ve done the chemo, your hair is starting to grow back and you feel better at tackling the surgery.
If you have surgery first, you’ve then got the chemo to “look forward to”. Yuk!
Just my way of thinking about it anyway.

I had chemo first. My tumour was big and the chemo shrank it to jus fragments. Was also in 1 lymph node.
Having chemo first should zap any stray cancer cells which may Have spread. As you mention vascular invasion I would be thinking chemo first. If you had surgery first then chemo would be delayed for maybe 6 weeks and I would be worried about what was happening in that period.
Thats how my ONC explained it to me.
Best wishes in whatever you decide x

When I was dx in 2010 I wasn’t given a choice, I was told chemo first. My lump was 45mm and was told chemo first and then mx. I had 4 AC followed by 4 Paclitaxol and had such a good response that the lump shrunk to dead non viable cells. As a result I underwent a WLE not a mx. I then went on to have rads and Herceptin as I was HER2. Obviously this might not be possible in your case but as every one is different you never know. I think it would be worth a try and as you have vascular invasion the chemo will get to work straight away.

Hiya There are quite a few of us having chemo first on this forum. I have just had my 3rd Fec and the lump is shrinking nicely and Onc very pleased. Hopefully it will enable a better chance of getting it all out with surgery. I also have at least one lymph node affected and I believe the thinking is if it is on the move then chemo is best first to avoid delay after surgery which I believe has already been mentioned. I was very uneasy about waiting to get the lump removed psychologically but I am pleased now as I can at least see the rotton treatment working. Chemo is s…t to go through but it does its job and I will be glad to get it out the way to be honest. I would be guided by your Onc but the very best of luck whatever you choose. This forum is brilliant for support. Jayneyxxx

Hi Bumpkin, I had chemo first. The onc gave me the choice, but her preference was for chemo first. The rational being that they can get on with it quickly and can monitor the effect. This means they have the option of modifying the treatment once they see the effect of the chemo. Your main lump is gone, so it might be harder to monitor the effects in your case. There is a risk that, if you have surgery first, you could get complications, like an infection, which would delay the chemo even more than planned. Some women can’t bear the cancer living with them and want it out for psychological reasons, but that did not bother me at all. Tbh, if I had had the diagnosis since March I would want to be getting on with the chemo.

I could not have recon at the time of Mx either (and still haven’t) and I really struggled with that - having the chemo first gave me some time to get used to the idea that I was going to be uni boobed, rather than just being catapulted into it whilst I could not think straight. I have since found out that many surgeons will do immediate recon, despite rads etc. So, if you have the chemo first, it gives you the opportunity to consider this idea and maybe find yourself a new surgeon if you want to see if it is possible.

The question to ask your Onc is "what would you do if I were your wife/mother/daughter/sister?

Good luck, Cress, xxx

HI Bumpkin. I wasn’t given the choice and had chemo first, but I reiterate what someone said earlier: the MX is a walk in the park after 6 rounds of chemo.
Tamsin x

Dear all
thank you so much for all of your advice which is unanimously in favour of chemo first, so I am not going to argue with that. Decision made! And it definitely feels like the right one. Thankyou and all the very best to you all.
Bumpkin xx

Newbie here and just diagnoised with grade 3. 70mm… chemo first to shrink. Good luck to each and everyone of u. I think I would have chemo first but only you can make the decision xx