surgery options after chemo but whilst on herceptin. very confused!!!

Ok so long day in hospital. Picc line out. Went fine. Met plastic surgeon. Hes not v happy that ive been the neoadjuvant way ie chemo first to shrink lump. He said if originally id seen him & he thought it wasn’t possible to have a lumpectomy then it would have been mastectomy. Reason being is, theres every chance the lump wouldn’t shrink enough with chemo (mines not worked hardly at all) & as im her2+ I need herceptin. So now ive had chemo & im on herceptin ( which he says is very similar to chemo as it kills bad and healthy cells and the immune system) its left me in a position of restricting what surgery I can have & high risk surgery as ill recover slower & if I get an infection my body will not be able to fight it and i’ll be in serious sh*t. So despite this he has offered me the following:

  1. lumpectomy but a lot of tissue has to be removed. He said he will take some fat from under my arm to try re fill my boob but has warned there will be a large indentation at least. He said a year after radiotherapy maybe have liposuction fat from belly injected into boob to fill it out but this isn’t always a permanent procedure as your body reabsorbs the fat quite often. You normally need this doing at least twice & yiu feel battered & bruised after surgery. There is also the possibility of the margins not being clear therefore needing a mastectomy anyway. If they are clear radiotherapy is a definite.

  2. mastectomy but save my own skin with an immediate implant put in. Which is more invasive surgery so longer recovery time & pain. He said my boobs would be out of line. He said there is a high chance i will still need radiotherapy which could possibly ruin the implant. He kept mentioning the fact that if i had an infection it would be immediate surgery to remove the implant and i will struggle to fight a bad infection due to my herceptin i have, also been told how to quit smoking a s a p. Plus ill have 2 drains fitted!
    After 12 months he said he would tweak the implant or replace if required, create a nipple and with a possibility of putting a smaller implant in my other side to align both boobs up.
    (So im assuming ill get a bigger bust out of this eventually)??? Bye bye A/B cup?!!

1-2% chance of a recurrence with mastectomy & 4% with lumpectomy.

I know number 2 mastectomy recon option sounds better but im so frightened of pain after surgery & petrified if I got an infection nurse even said it can result in death!! I asked if infections are high possibility & she said most people are fine but it does happen & with my herceptin issue its worse.

I have got to make a decision by monday. Surgery is booked for 28 april either way. Help. Heads a mess!!!

Helenstevo

Whilst you wait for the other users to reply with experience and knowledge may I suggest you give the BCC helpline a call on 0808 800 6000.  Here you can talk through your concerns and options with a member of staff who will offer you a listening ear as well as emotional support and practical information.  Lines are open today until 2pm and Monday to friday 9 to 5pm

Best wishes Sam, Facilitator

Thank you so much for your information gilly. I hope your doing well. Can I ask how much pain you were in after surgery & what happens at the infills & how painful is it please? I decided on lumpectomy & pulling some fat from under my arm to slightly fill the warned about big indentation & after a yr (after rads) lipo from tummy put in breast (which could take a few goes ive been told as your body reabsorbs fat)! But im thinking I may have made the wrong decision. Im noticing my lump grow I think whilst im awaiting surgery (28th) & it was 2.5cm in a cup breast is already pushing it for a lumpectomy! Also peace of mind after with regards to recurrence. Also & I know this sounds bad & vain but I hate my small bust especially as im a sz 14 so out of proportion but think ill end up with bigger breasts in the end as told other good side will require an implant in 12mths to match up. Saying that id prefer a double mastectomy but I think itll be a no! At least things would match up better & also I wont drive myself crazy with worry with checking as much!! What screening is offered if you have implants? Im just so scared of the pain from this surgery compared to a lumpectomy xx