Radiation Oncologist Appointment

On Monday December 1st Judy met with Dr. Ruffer, a radiation oncologist at Good Shepherd Hospital. At this time we are not sure if radiation will be needed – that will be determined after the Mastectomy, once they look at the tissue. We wanted to get his opinion as to whether or not having implants before getting radiation (if needed) would hinder the effects of the radiation in any way. Also, if he saw more recurrences of breast cancer in patients who got breast reconstruction before they did radiation.

Dr Ruffer explained that the need for radiation would be determined after surgery. The staging process included getting the cancer out, seeing the lymph nodes and then deciding on treatment options – local & regional (surgery/radiation) and systemic (chemotherapy). This would depend on the size of the tumor, if there are positive margins after the breast is removed, and if it has spread to the lymph nodes. She has a greater chance of needing radiation because the cancer is multi-centric (that even though they are removing the breast there is still a chance that there can be cancer cells on the chest wall).

She would do chemo first and then radiation. Radiation would be for 15 – 20 minutes per day, 5 days per week for 5 – 6 weeks. Dr. Ruffer suggested that Judy do radiation with his partner at Illinois Masonic in Chicago, Dr. Yajnik so that she does not have to make the trip from the city for that many days in a row. Radiation will make her tired and may take weeks if not months to get better however it is usually not debilitating and she should be able to continue working while getting radiation.

It was Dr. Ruffer’s opinion that the implants would have no effect on their ability to get to the cancer with radiation and that it would be better for her to get immediate reconstruction if she was getting implants. Radiation can cause thinning of the skin and scar tissue which can make it more difficult to do reconstruction after radiation. If Judy decided to go with a TRAM, it would be best to do a delayed reconstruction due to the effects of the radiation on the skin.

Now the decision is up to Judy . . . which procedure does she want to get? Which plastic surgeon? Immediate or delayed reconstruction? And the decision had to be made today because the surgery has to happen this week. As Judy told the doctor, “I can’t usually decide what I want for lunch and now I have to decide what kind of breast I want?” Overwhelming doesn’t begin to describe it.

As of Monday night, Judy has decided to go with implants and immediate reconstruction. At this point we are just waiting to hear back from the surgeon as to when surgery will be scheduled.