Anyone have experience with APBI (Partial Breast Irradiation)?

@maymore—I forgot to mention that I did have a lumpectomy.

Your diagnosis is exactly what I had, and I chose to skip everything almost! I decided to radically change my lifestyle, and so far, so good! That was three years ago! I do take Raloxifene for severe osteoporosis, and that does have some breast cancer protective properties.

@susanmfc
I did have a second surgery that was cosmetic only.
Before the first surgery, I met with the plastic surgeon and he said I had 3 options. Lumpectomy, mastectomy, or lumpectomy with tissue rearrangement to fill the space, which would essentially be a breast lift, and surgery on the other breast to match. Lesion was in LOQ which may have been the reason it was a “lift”.
At the cancer center I was at, plastic surgery was just part of the lumpectomy. The oncology surgeon cuts out the lesion then the plastic surgeon steps in and closes.

I chose to do both breasts, At the time I did not know how much radiation would be recommended, I had a general understanding, but pathology after surgery often drives that decision.
When I met with the radiologist after surgery I brought with me the research from an Italian study showing 5 days may be enough. Protocols at that time were still for multiple weeks of radiation. She said 5 days would be appropriate for me, so I had partial breast radiation, great!! But the plastic surgeon had expected me to have whole breast radiation for extended weeks - and made that breast larger. I can’t fault him really, as it was the expected length of treatment in early 2022.
The radiated breast never shrunk (expected 15-20%), and was 148 cm3 larger. The surgeon said the difference in size fell within the size difference they thought was acceptable, but he was willing to reduce the size. Two years later I had it reduced.

In this forum, with so many women dealing with much bigger issues, life threatening decisions, I feel uncomfortable that I put so much interest on cosmetics. But reducing the size did bring the nipples into alignment and I no longer need an insert on one side.

The takeaway, if it will help anyone else, is have a VERY detailed discussion prior to surgery about what ifs! I thought I had covered everything, and asked a ton of questions. But I didn’t think that I needed to consider length of radiation treatment as part of the surgery plan.

The other takeaway is that the radiated skin is not as pliable. The first surgery pre-radiation the shape and feel of the breast was softer. After radiation I thought my breast skin still felt fine - but it was different with the new sutures and rearrangement of tissue. It is still going through a softening, but the suture line is “tighter” (hard to explain) it kind of reminds me of sewing leather. So a discussion on “how might results be different” in terms of tissue quality and esthetics might be helpful if having multiple surgeries - and trying to make decisions.
I am satisfied with my results; I did go to PT to work on softening the suture line; and my next scan will be an MRI to view the 7 cm seroma that I have along the suture line, probably a result of the thickened skin (the location means part of it not visible on a mammogram).

I apologize this is so long - difficult to explain in a few words.

@newtosc I’m in same boat as you. These decisions are tricky aren’t they? I’m getting a second opinion tomorrow about 5 day radiation but am still not 100% I want to do either it or drugs. If you see this, would love to know how it’s all going for you now, 4 months since your post. Thanks.

@triciaot
I’m considering doing this and your post was helpful. Thank you. I’m curious about rearranging breast tissue and the plastic surgery you mentioned. Did you have another ‘correction’ surgery for cosmetic reasons or was this all part of lumpectomy? Thank you. Hope you’re doing well.

It is very hard to know what to do - I start the 5 day program on my left breast and it all worries me. My Onc says that I could almost forgo 5 years of Tamoxifen which I would prefer. I am drug adverse and try to
manage thru exercise and foods. But... then what if? It's all a crap shoot. I am probably going to do the radiation to get to 99%, try drugs to see how I do and go from there. Sad part, is I waited a bit too long to do a ton of research but also, radiation is not something I can do in 6 months - Now is the time..

I had partial breast radiation, right breast, 7 mm ER/PR+ DCIS no nodes, intermediate grade, 68 yo at the time. Radiation was hypofractionalized 3000 Gy total, 600 a day for 5 days.
I attached a photo of the radiation pattern, more was targeted at cancer site.

I had no surface skin issues. They say I have thickened skin, but I can’t really tell. I have some lumpiness in that area, it seems to be unknown if it’s internal scar from the surgery or necrosis from radiation. There was a fair amount rearranging of the breast tissue - I had a lumpectomy and a plastic surgeon fixed it so it’s not noticeable. I’m now 71, and on 5 mg tamoxifen.

I heard about Proton PBI. Seems like a good choice, but few venues have it. I am thinking also about asking my Radiation Onco about the three-day course with precise beam delivery. There doesn't seem to be a lot of talk about this. I had Stage 1a, estro+, prgestro+, small tumor 4.5mm. Good prognosis, but I am not sure about radiation. Definitely no aromatase inhibitors. I am 78.

I met the criteria for APBI so that’s what I had - 2 sessions a day for 5 days. I had some uncomfortable sunburn-like after effects, but never had the intense fatigue people describe from longer courses of radiation. So I was happy to skip that part and be done in just a week.

Absolutely no side effects at all from the 3-day partial breast radiation!!!👍