I will be explaining the course of treatment that we decided upon on this page.
Click on the links below to read about:
The Treatment Options.
The surgeon explained our options for treatment:
- Do nothing special and have a yearly mammogram as usual. She advised us against doing this, she did not feel that this was enough.
- Start taking a cancer preventative drug called Tamoxifen, plus have a mammogram in six months, then have an MRI in six months. The Tamoxifen would need to be taken for a period of five years. The mammogram and MRI cycle would need to be repeated every year.
- Submit to a double Prophylactic Mastectomy procedure, which removes the breast tissue from both breasts. Once the breast tissue is removed a procedure is done to reconstruct the form of the breasts.
We settled on starting Diane on the Tamoxifen right away and then pondering where to go from there.
Where Do We Go From Here.
We were not sure how serious the surgeon was about #3, why was this an option, Diane did not have cancer. We (mostly me) spent the next week at the computer doing research. The information that can be found on the internet is enormous, it can also be very overwhelming and addictive. How much info is enough, did I miss something, my head was spinning and ready to explode at times. Appetite, sleep and work suffered. The more I read, the more feasible #3 was looking.
It was New Year’s Eve and finally time for Diane’s follow-up appointment with the surgeon. We had so many questions that we needed answered.
Some Of The Subjects We Discussed.
The surgeon and her assistant sat down with us and spent as much time as necessary to discuss all the subjects in detail.
Any thoughts and comments that we had following the discussion with the surgeon and her assistant appear in blue type.
The Pathology Report And Diagnosis.
We discussed the pathology report in more detail than we were able to do over the phone on Christmas Eve. To read a detailed explanation of the pathology report and the diagnosis click on the link below.
Genetic Testing.
The surgeon told us that since Diane and her mom were both age 50 or over when their masses showed up, the insurance company may not be willing to pay for the genetic testing.
The plastic surgeon thought we may want to push the insurance company to pay for the testing since Diane is barely 50 and her mom was only 54, plus the fact they both seem to be physically young due to their youthful appearance for their ages.
This is important for two reasons. One would be that the presence of a mutated gene would make our decision a lot easier. The second deals with the ovaries because the gene mutation also increases the risk for ovarian cancer.
Family History of Breast and Ovarian Cancer.
Details to come.
Risk Reducing Cancer Drugs.
We discussed the benefits and side effects of the Tamoxifen in detail. What to expect as far as a decrease in the probability of a future diagnosis of cancer. How to mitigate some of the side effects. When to consider stopping the Tamoxifen if it was not possible to effectively deal with the side effects.
The Tamoxifen is supposed to reduce the risk by one half. During my research I did find some info about the effectiveness of the Tamoxifen being negligible in some people due to factors present within their body. There is supposed to be testing available to check how effective the Tamoxifen will be. (We did not pursue this because we had decided on the mastectomy procedure.)
Diane knew some of the side effects that the Tamoxifen caused due to her mom’s experience with it. Her mom suffered through the various side effects for approximately one year. She quit taking the Tamoxifen because the side effects were too difficult to deal with and her quality of life suffered greatly while taking the drug.
The Mammogram And MRI Cycle.
The surgeon wanted Diane to have a mammogram in six months and then six months later have an MRI. This would continue indefinitely causing a cycle of tests with the emotional ups and downs associated with it.
Mammogram’s are always a painful experience for Diane due to the small size of her breasts. Then there is the apprehension leading up to the test and the waiting for the results. The breast MRI is a long painful experience too, due to the different positions her body needs to be in for extended periods of time. Then again there is the apprehension leading up to the test and the waiting for the results.
Breast Tissue Density.
The surgeon explained that Diane’s breast tissue is dense which causes difficulty in detecting anomalies in the breast tissue.
During my research I found out that the type of cells that have been causing the concern are difficult to detect under the best of circumstances with a mammogram. Therefore the standard mammogram is not as thorough a tool to use. We may be getting a false sense of security from the mammogram results.
What If Another Mass Was Found?
The surgeon told us that if another mass was found she would suggest that we would need to seriously consider the Double Prophylactic Mastectomy then.
Some evidence was found in the pathology report that the second mass was faster growing than the first. We were not sure if we wanted to take the chance that a new mass would appear in an even more aggressive fashion. My research confirmed that this could be the case with future masses. (If the pathology report had shown classic LCIS cells instead of the more aggressive PLCIS cells, that may not have been an area of immediate concern.)
Double Prophylactic Mastectomy?
The surgeon told us that PLCIS affects both breasts, it was just a coincidence that all three lumpectomies were performed on the left breast.
Nipple And Skin Sparing Methods.
The surgeon told us that she suggested using the nipple and skin sparing method in this case. She also told us that she may core the nipples once she sees the conditions present during surgery.
This was welcome news. With the skin sparing method the advantage is that skin would not need to be removed from another location and re-located to the breast. There is also a chance that some sensation may return to the skin that is left to cover the breast area. With the nipple sparing method a new nipple does not need to be constructed in a later surgery and the areola does not need to be tattooed around the constructed nipples.
Chances Of Cancer Occurring Anyway.
There is still a minute chance that cancer still may appear. It does not matter how careful the surgeon is in removing the breast tissue, some cells will be left behind. Even with the chance that the small amount of cells that are left develop cancer, the risk is virtually non-existent compared to the risk of not proceeding with the mastectomy procedure.
Methods Of Re-Constructing The Breasts.
The breast surgeon explained some of the reconstruction options in general. Then told us to make an appointment with the plastic surgeon to discuss the options in detail so we could make an informed decision about whether we wanted to choose the mastectomy and breast reconstruction course of treatment.
To read more about our visit with the plastic surgeon click on the link below.
More questions and subjects discussed to be added yet…
A Blog For Diane 
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