Surgery first or Chemo first ??? HELP

Hi, this is my first post and I need help. I am 35 with two beautiful little boys under 6. No family history, non smoker who had my boys at 28 and 32, breast fed both for 6 months, and have just been diagnosed with grade 3, 2cm breast cancer. So I am still in total shock. I have found out yesterday that luckily it hasn’t spread to my nodes after my senital lymph node operation. The plan I was following was to have chemo first and then surgery, but now they have offered surgery first then chemo, both followed by radiotherepy, herceptin etc. They have left the decision up to me, as both will have the same end result. The chemo will start on 5th Nov but surgery won’t be until 18th Nov ??? Which option should I do first. Half of me wants my body rid of it but the other half is worried that if I wait for three weeks does it have the potential to spread ?? Please help.


Dear claireb

Welcome to the forum although I’m so sorry you find yourself here.

As well as the support you will receive on this forum from fellow members, you could also call our Helpline to talk things over.  They will be able to offer you practical information as well as emotional support.  They are open today until 2.00pm.  They are also open on weekdays from 9-5.  The number is 0808 800 6000

Very best wishes


BCC Moderator

Hi there!


Really sorry that you have to find yourself here, but rest assured the advice you will get from everyone on here will be fantastic.  It must be very difficult being told that you can make the decision about chemo/surgery, especially has you are probably still in a state of shock over this whole business.  For what it’s worth, I would probably opt for the surgery first, mainly because Christmas is coming!  With a young family Christmas tends to be quite a full on/exciting time for everyone and if you are two months into chemo you won’t feel much like celebrating or organising unless you are very lucky, nor will you be able to go to school events/pantomimes etc at certain times of your chemo cycle because of possible infection.   If you have surgery first whether it be a wle or mx you will be up and running well before Christmas and will be able to enjoy it.   On the other hand, surgery is definitely the easy part of this whole business, so you will have to go through Christmas knowing that chemo is your New Year’s gift. Don’t worry about any concerns about spread - 3 weeks is neither here nor there under these circumstances.  And bear in mind that these professionals are fab for the most part, so they wouldn’t suggest something if they weren’t entirely happy with it.


There are loads of different threads on here for various stages of treatment, so I hope you will join the relevant ones for more advice.  The chemo monthly threads are especially helpful - when you’re feeling rubbish there is always someone to pick you up.

Good luck with whatever decision you make.



Hi Claire,


Last year I was dx with invasive ductal breast cancer on 1st November and I had my surgery on 12th December (MX with SNB). Grade 3, 3 nodes removed, only one with cancer cells in it. I had recovered enough to enjoy Christmas. I’d have hated knowing my lump was still there over Christmas while I waited to have chemo first. I don’t think the extra three of weeks waiting for surgery first will make much difference to to the status of your cancer, As you have had your sentinal nodes removed, there aren’t many places for it to spread to. 


Whatever your decision, wishing you all the best.


poemsgalore xx

Hi Claire,

It is a very personal decision, and whichever way you decide is right for you.  As the others have said, three weeks will not make any difference to your outcome - though I can recall being frightened by a week delay soon after I was diagnosed, so I understand your concern.


I had chemo first - no real choice, my tumour was massive, and they wanted to shrink it before surgery.  My surgeon did say he could operate straight away if that was what I wanted but he ‘strongly encouraged’ me to have chemo first.


I was dx at the end of August 2010, so my chemo ran from mid September to literally 31st December, I had surgery at the start of Feb 2011.  One of the advantages of having chemo first is that it allows the surgeons to see (to some degree) if the lump is responding, and if not to switch to a different drug regime.  In some cases (not mine) it can also mean less radical surgery is needed, e.g. a WLE (lumpectomy) rather than a mastectomy.  For me, it also meant time to explore reconstruction options ‘at leisure’ as I was going to have a mastectomy come what may - I found this very helpful, and made a far more confident decision.


I totally understand what the others have said about Christmas and chemo - I had my fifth dose two weeks before Christmas and was able to enjoy a good time (and a rather busy one given my job!).  I was getting tired by then, as the effects are cumulative, but with a bit of planning and ‘out sourcing’ of boring jobs, I was able to get through.  Maybe this year your OH (other half) could cook the dinner, or you could buy in some of it ready made?  Online shopping may not be as miuch fun, but it is easier on the energy levels. Christmas during treatment is a funny old place to be (as is birthday, I had both within a week!) but can still be very precious and enjoyable.  Somewhere I have a photo of me with a santa hat over my bald head and a huge smile on my bloated face -  I had fun even if it was a bit bittersweet.  What  your family will cherish most is Christmas all together.


Not sure if that helps, but it’s a different perspective.

Hi Claire


Have they told you what type of surgery you’ll be having? If they are suggesting MX, or you are thinking MX is what you prefer, then go for surgery first. Some of the hospital now offer oncotype dx test, or if you are in London Royal Marsden piloting a similar test called PAM50 which determine whether you benefit from chemo after surgery.


I was advised by both surgeon and oncologist to have chemo first for two reasons; one because I fall under young women category,  and two to have a less invasive surgery. I did end up having chemo first, but because tumour didn’t response to the first 4 sessions, I spent most of my time worried and anxious. I still have one more session and luckily the last ultrasound showed some shrinkage. if this happens to me again, I will definitely go for surgery first.


At the end is your body and your decision, do what you feel comfortable with. 


Good luck,

Mahsa x

Thanks for all the fabulous responses. I am a little clearer in my mind now. I would be having a lumpectomy not a MX. As they have not brought that up as an option. I am going to have a chat with my nurse and then make a decision then, I will let you know which way I decide. Thank you ladies, it feels good to be part of this together x

Hi Claire
I’m 54, and my sons are 27, 24 and 20. I had a lumpectomy first on 6 August, but unfortunately because the tumour was massive 7cm (grade 2) I had to have a mastectomy two weeks later, apparently it didn’t appear that big on the MRI because of the type - it’s lobular BC. Luckily my lymph nodes were clear. I sometimes wonder why they didn’t offer me chemo first to shrink the tumour and then maybe save my breast, but to be honest I’ve got peace of mind now that the cancer has gone completely. I’ve had one of six cycles of chemotherapy so far and personally, especially as you have a young family and you’re so young, I would have the surgery first, as this is the easy part, and enjoy Christmas.

Of course at the end of the day it’s your choice, I’m quite relieved I didn’t have to make these decisions.