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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Suggest treatment for recurrent breast cancer

Please help by giving me your expert advice! I had a biopsy done on my left breast Friday, March 14, 2014, due to a 2D screening digital mammography with 3D tomosynthesis. Besides the mammogram, I had an ultrasound to show that the three masses were not cysts. The three masses were 1 cm., .7 cm., and .3 cm. very close to each other and appeared to be joined and superficial or close to skin - the radiologist called the shape similar to a barbell. The report says that the breast parenchyma is composed of scattered fibroglandular densities...there is a new nodularity in the upper central left breast...coarse calcifications are again noted...no suspicious cluster of microcalcifications is seen. HISTORY: December 20, 2011 - 6-7 hour surgery for removal of ruptured silicone breast implants in both right breast (1998) mastectomy and left breast implant to match breasts. Left breast reconstructed without implant and right breast insertion of silicone implant. December 21, 2011 - blood clot in left lung nearly 24 hours after surgery; taken to emergency (different hospital); due to focus on blood clot and hiatal hernia that bled, antibiotics not taken for breast surgeries. Severe reaction to gaseous anesthetic (hallucinations). January 9, 2012 - emergency visit to hospital due to infected right breast (skin had been radiated in 1988, was thin, and unhealthy). Right breast implant removed; severe infection with 5-day hospital stay. January 9-August 28, 2012 - on Coumadin. September 21, 2012 - a 6-7 hour surgery on right breast to attempt reconstruction of implant to right breast. In addition, muscle/skin flap taken from back to replace old tissue resulting from prior radiation. Due to use of gaseous anesthetic (even though doctor told not to use gaseous due to prior hallucinations), I suffered severe reaction after post-op and as a result tore stitches within right breast. Three day stay in hospital. October 16, 2012 - Removal of right breast implant after three weeks on antibiotics. Note: I continued to teach part-time online graduate university students and mentor PhD students ONLINE. 1988 Original breast cancer in right breast found as microcalcifications (very tiny - too small then for diagnosis) right lymph nodes removed and breast cancer had not spread. Radiation followed. I was 39 and the first mammogram ever had. 1998 Recurring breast cancer in right breast (even smaller) on mammogram. Right breast mastectomy and left breast implant to match right (far too large an implant - replace on two occasions within first few months after reconstruction of right with little success). Right breast reconstructed and no sign of possible cancer until last mammogram March 10. Right breast reconstruction: I have a reconstruction planned for my right breast (pouch to inject saline) on March 25, 2014 in Orange County, CA, due to my plastic surgeon s place of work. I moved to Phoenix summer 2013. NOW, with result of mammogram/ultrasound received March 10 and left breast biopsy of three masses on March 14 (results not until Tuesday, March 18 or 19 at latest), I am uncertain what to do about my right breast reconstruction? My plastic surgeon knows that Tuesday I ll find out the biopsy and that until then, I m on hold about coming from Phoenix to OC for reconstruction. QUESTION: Does the shape of the masses indicate possible cancer? I asked the radiologist whether edges were unsmooth and she said they were smooth. I know I have to wait but have you had any experience with this odd shape being cancer? QUESTION: I asked the breast surgeon in Phoenix if the masses could be silicone left over from the surgery removal of the ruptured implant in December 2011. She said silicone usually shows up very bright on the mammogram. QUESTION: Is there any possibility the odd shapes could be old silicone? QUESTION: If the masses are cancerous, my plan would be to have a mastectomy and never have to worry again about cancer. What is the recovery time after a mastectomy? Before, I was on a break in my PhD program and returned within 2 weeks to take a reduced PhD program - 3 instead of 4 courses. The second time, it was Christmas time and I took a 3-week break before looking for new work which I started right away. QUESTION: If I have to have chemotherapy (did not before) and/or radiation, how long does it take typically to be mentally alert to return to work - my PhD mentees - a small class I could simply not take on this term online? Lots of questions, I know. If you can give me any help, please let me know. Once again, the biopsy results are not known. But hearing from you to get more information depending upon the results would be so very helpful. Please help. Wendy Zender, PhD YYYY@YYYY
Fri, 5 Jan 2018
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Oncologist 's  Response
HI

Surgery. For recurrent breast cancer that's confined to the breast, treatment usually involves removing any remaining breast tissue.

If your first cancer was treated with lumpectomy, your doctor may recommend a mastectomy to remove all of your breast tissue — lobules, ducts, fatty tissue, skin and nipple.

If your first breast cancer was treated with mastectomy and the cancer comes back in the chest wall, you may have surgery to remove the new cancer along with a margin of normal tissue.

A local recurrence may be accompanied by hidden cancer in nearby lymph nodes. For this reason, the surgeon may remove some or all of the nearby lymph nodes if they weren't removed during your initial treatment.

Radiation therapy. Radiation therapy uses high-energy beams, such as X-rays, to kill cancer cells. If you didn't have radiation therapy for your first breast cancer, your doctor may recommend it now. But if you had radiation after a lumpectomy, radiation to treat the recurrence isn't usually recommended because of the risk of side effects.
Chemotherapy. Chemotherapy uses drugs to kill cancer cells. Your doctor may recommend chemotherapy after surgery to reduce your risk of another cancer recurrence.
Hormone therapy. Medications that block the growth-promoting effects of the hormones estrogen and progesterone may be recommended if your cancer is hormone receptor positive.
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Suggest treatment for recurrent breast cancer

HI Surgery. For recurrent breast cancer that s confined to the breast, treatment usually involves removing any remaining breast tissue. If your first cancer was treated with lumpectomy, your doctor may recommend a mastectomy to remove all of your breast tissue — lobules, ducts, fatty tissue, skin and nipple. If your first breast cancer was treated with mastectomy and the cancer comes back in the chest wall, you may have surgery to remove the new cancer along with a margin of normal tissue. A local recurrence may be accompanied by hidden cancer in nearby lymph nodes. For this reason, the surgeon may remove some or all of the nearby lymph nodes if they weren t removed during your initial treatment. Radiation therapy. Radiation therapy uses high-energy beams, such as X-rays, to kill cancer cells. If you didn t have radiation therapy for your first breast cancer, your doctor may recommend it now. But if you had radiation after a lumpectomy, radiation to treat the recurrence isn t usually recommended because of the risk of side effects. Chemotherapy. Chemotherapy uses drugs to kill cancer cells. Your doctor may recommend chemotherapy after surgery to reduce your risk of another cancer recurrence. Hormone therapy. Medications that block the growth-promoting effects of the hormones estrogen and progesterone may be recommended if your cancer is hormone receptor positive.