Mastectomies are not an option for those over 65???!!!

Posted by sandyjr @sandyjr, Jan 22 7:35am

A friend of mine has had breast cancer twice…DCIS and IDC….both breasts….as I have. She told me that she had suggested mastectomy to her surgeon the second time and that doctor, her oncologist and her gynecologist told her that it is not done for ladies over 65. They do not do it. She is a young 75 and certainly could handle such surgery. I am 70 and last year I had a bilateral mastectomy with diep flap reconstruction. The first surgeon I went to had no problem doing the surgery, but said that I was too old for diep reconstruction, I would have to get implants. I did not like that surgeon and would never have used her….she was rude and crude saying “another nipple in the bucket” over and over when discussing mastectomy. I was disgusted and angry. I did not know where to turn, so made an appointment with a plastic surgeon that had given a lecture on breast cancer reconstruction. Luckily I had attended the lecture and decided to make an appointment with him. He had shown pictures of women that had had surgery and reconstruction into their 80s. That was the best thing I ever did. After meeting me and hearing my story…two breast cancers and genetic mutation and horror appointment with the crude surgeon, he told me that I could not have nipple sparing surgery because of the radiation I had had, but that I could have the diep flap and he recommended a different surgeon. He has been the best thing that has happened to me since my breast cancer experience began. He is kind, totally explains everything, listens to everything you have to say and tells you what to expect. From the get go, he told me he could not make me look perfect, but he also said he does not take cases unless he knows he will be successful. This man truly has given me hope and my wish is that everyone be lucky enough to find a doctor like him. I am nearly through the process as it takes a while to complete and I am delighted with my new breasts. So, can someone tell me if/why mastectomies are not done for older ladies. That certainly was not the case for me. My suggestion is…do your research, decide what you want and do not go by what the first doctor tells you. I got 50% of what I wanted….no on the nipple sparing mastectomy (but I did have skin sparing), but yes on using my own tissue for reconstruction…no implants. I thought the surgery was remarkably easy…very little pain…getting back up to speed took about 3 weeks (its a 10 hour surgery and you have to be very careful how you move so as not to disrupt the microsurgery done to move the tissue from the belly to the chest). He has given me hope.

I was 68 when I had my bi lateral mastectomy, skin sparing with implants. I was so surprised as to relative pain free healing process and recovery time. The expanders were a bit uncomfortable at times but not overwhelming. A year later the implants were placed.
At almost 71 now, it was the best choice for me on advice from my surgeons at Mayo. When it comes to these decisions we need to find doctors that are willing to work with our needs!

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I also was surprised at the lack of discomfort. The only pain I had was a HUGE headache…the surgery was long. I believe that was from the anesthesia. Even the very wide incision across my belly where they harvest the skin (and some blubber…lol) from was pain free. I thought for sure it would be a lot more difficult than it was. Of course having the perfect doctor (plastic surgeon) helped. I went into this confident that the outcome would be great and it is.

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Hi Sandy. I don't know about that age thing. I was told no mastectomy (at 57) because I was diagnosed IDC stage 4. At that point they no longer remove the primary tumor and just focus on whole body treatment; which in my case is a pill form of chemo with the Estrogen blocker, Letrozole, and a bone strengthener. When they thought I was stage 2 it was almost automatic. They put in a port for infusion chemo, planned to shrink the tumor and then proceed with a lumpectomy or mastectomy (depending on how far they were able to shrink it), them Chemo and radiation to finish it off before reconstruction. Stage 4 after the CT Scans and such changed all that. I'd like a mastectomy to get rid of the primary and focus on the metastasis but they don't do it because (I was told) they don't want to radiate, infusion chemo and weaken my body that is strong in it's current state. I'm in it for the long haul and infusion and radiation should be saved as a last resort once we run out of other options.

Peggie

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Here is an age related funny thing to add to the stories you girls have. I was in my 30s when I was diagnosed. I really wanted a bilateral mastectomy, no reconstruction. I ride horses and the thing I love most has always been painful, so this was a no brainer for me, especially since they were doing a complete hysterectomy ovaries included, I would not need them. My surgeon said they will not do mastectomies anymore especially with younger women, this was during that period when they first figured out lumpectomies were “better”. So I got the insanely disfiguring breast conserving surgery that left me with less than half of one, and a deep scar in the other. I have since lobbied several times for removal since I still ride those horses. The answer is always no, so now I have this amazing contraption that keeps them absolutely motionless, yippee. After all of that, the nice lady at the lingerie shop saved me.

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auntie, That's a good one for "when life gives you lemons". Glad it all worked out for you.

I am left with a disfigured breast only because the tumor pulled everything up and outward like an octopus grabbed up the "meat of the breast" and drug it up towards my armpit. The underside became ulcerated and tore as it was stretched leaving me with a 2 inch by 1 inch opening that has since healed as the tumor is being killed off. They see no need to "fix" things. Won't remove what's there and won't try to reconstruct the lower half of my breast that is basically missing. I don't get it. Is it not worth it to the insurance companies?

Peggie

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Check with your insurance company. If you have Medicare, they pay for reconstruction I think if you have had breast cancer or the BRCA gene. What Medicare doesn’t pay will be picked up by your supplement…at least they have for me. I do not have a supplement. I retained my insurance from my job when I retired. It is a bit expensive, but I have peace of mind. I am not familiar with the Medicare supplements, but I THINK if Medicare pays for something, then so does the supplement. I know nothing about Medicare Advantage plans. I have original Medicare. Also, just because your doctor/doctors do not want to fix your breast doesn’t mean it can’t be done. I had a breast surgeon for the bilateral mastectomy and I had 2 plastic surgeons…they work together. Only one of the plastic surgeons is my doctor, the other is his associate. When I went to the plastic surgeon that is MY doctor, he brought the second Plastic surgeon in to look at me and they decided right then that they would do it. I had 2 surgeons at this time because while the breast surgeon is doing the mastectomies, the plastic guys are on each side harvesting the tissue from my abdomen and will transplant it to my breast area. They are micro surgeons…which is what you need for diep reconstruction as blood vessels have to be cut and reattached to blind vessels in my chest when the other surgeon is done. Both or these guys are brilliant. My doctor just looked at me and he knew what he was going to do. I am so pleased. I am not sure if you can have diep reconstruction if you are skinny, so you would probably get implants and I do not think you need a micro surgeon for that. Shop around and be sure to look at pictures of their work. My chest was badly deformed from the two lumpectomies…they did not even come close to matching. Now I look and feel normal. I have feeling in the transplanted tissue, but not stimulating feeling in my nipples. I have no regrets. My doctor had no problem doing this surgery and I am 70.

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@sandyjr

Check with your insurance company. If you have Medicare, they pay for reconstruction I think if you have had breast cancer or the BRCA gene. What Medicare doesn’t pay will be picked up by your supplement…at least they have for me. I do not have a supplement. I retained my insurance from my job when I retired. It is a bit expensive, but I have peace of mind. I am not familiar with the Medicare supplements, but I THINK if Medicare pays for something, then so does the supplement. I know nothing about Medicare Advantage plans. I have original Medicare. Also, just because your doctor/doctors do not want to fix your breast doesn’t mean it can’t be done. I had a breast surgeon for the bilateral mastectomy and I had 2 plastic surgeons…they work together. Only one of the plastic surgeons is my doctor, the other is his associate. When I went to the plastic surgeon that is MY doctor, he brought the second Plastic surgeon in to look at me and they decided right then that they would do it. I had 2 surgeons at this time because while the breast surgeon is doing the mastectomies, the plastic guys are on each side harvesting the tissue from my abdomen and will transplant it to my breast area. They are micro surgeons…which is what you need for diep reconstruction as blood vessels have to be cut and reattached to blind vessels in my chest when the other surgeon is done. Both or these guys are brilliant. My doctor just looked at me and he knew what he was going to do. I am so pleased. I am not sure if you can have diep reconstruction if you are skinny, so you would probably get implants and I do not think you need a micro surgeon for that. Shop around and be sure to look at pictures of their work. My chest was badly deformed from the two lumpectomies…they did not even come close to matching. Now I look and feel normal. I have feeling in the transplanted tissue, but not stimulating feeling in my nipples. I have no regrets. My doctor had no problem doing this surgery and I am 70.

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@sandyjr You make a good point as to checking with your insurance company. I have a Medicare Advantage policy through my former employer. Medical professionals always are telling me that Medicare won't pay for something (like genetic testing, etc.) and yet my particular policy does pay for it. There are dozens of Medicare Advantage policies and each is somewhat different… crazy as it is.

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Medicare paid for my genetic testing BUT my mother and cousin and I had all had breast cancer…my cousin twice. I do have a genetic mutation. I had no problem deciding on the bilateral mastectomy. I think it depends on your and your family medical history.

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@sandyjr

Medicare paid for my genetic testing BUT my mother and cousin and I had all had breast cancer…my cousin twice. I do have a genetic mutation. I had no problem deciding on the bilateral mastectomy. I think it depends on your and your family medical history.

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@sandyjr
Sandy – you're right about mastectomy. Although I wasn't full mastectom, mine was "partial" which took me from about a "DDD" or "F" down to what I call "A-" or pretty well flat. Am so much better off…no more shoulder pain, I can actually sleep on my stomach without first having to pull my breasts into position(!!!), and no longer down by my waist. Whew…I'm never looking back.

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Agree, get a surgeon or oncologist that is a good fit for you. They have widely different philosophies. If not a good fit, move on. Ask your gynecologist, primary care, or other breast cancer patient for a referral. Check the reviews online.

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