Hello,
I am not a lactation professional, just someone who appreciates all that
you do and that you'll let lay people like me listen in here at lactnet.
But every once in a while something comes up where I have some smidgen of
experience and I hope it's appropriate that I add to the conversation.
First, for Polly's question:
I have the BRCA-2 mutation. I started having yearly mammograms and MRIs at
age 40 when my youngest was two years old and I was tandem nursing. The
nurses at the imaging center usually tell me that the doctor on duty
recommends I not bother with screening while I'm nursing because they won't
be able to read the results as clearly, but I always say please do it
anyway because we're looking for changes over time. Also, if we don't even
try to look there's zero chance we'll find anything.
I see my breast surgeon once a year and am planning on a prophylactic
mastectomy once my youngest weans. I met with another breast surgeon and a
plastic surgeon to discuss my surgery and no one on my care team has
recommended weaning.
Of course, I am partially basing my decision to let my child self wean on
the fact that my family history seems to suggest that I've got a bit more
time. If I was closer to the age when my mother and grandmother were
diagnosed with breast cancer I might feel a bit more pressure to move
things along more rapidly. Is it possible that your patient's doctor is
concerned that she needs to get the surgery done sooner rather than later?
And for Esther's question:
From what I have learned, even if a woman has a biopsy that shows she's got
breast cancer, it usually takes around a month before they can get her in
for surgery. It will also take time to get her BRCA test results (mine took
over two weeks) and the MRI done. She would probably want to ask her
surgeon what the lead time is, but I would be surprised if she had less
than two weeks to prepare, and would expect it to be closer to a month.
I asked about weaning before surgery and was told that it was not
necessary. Admittedly I'm making a lot less milk with a 5.5 year old
nursling vs. your friend with her 11 month old, but the breast surgeon did
not seem to be concerned about it at all.
As far as how long she'll be in the hospital, that depends a little bit on
if she's having reconstruction and what kind of reconstruction she has. I
would expect she'd be in the hospital for about three days if she just had
a single mastectomy. If she has immediate reconstruction with implants that
would add a day or two. If she chooses to have a flap surgery of some sort
that could add another day or two. I have been told that when I have my
double mastectomy with DIEP flap reconstruction I'll likely be in the
hospital for about five days, but be recovering for up to six weeks.
I know this is just anecdotal information from my personal experience, but
I hope it helps you and your patients.
Hilary Pollock
> Date: Tue, 10 May 2016 15:25:48 +0000
> From: "Westra, Mary" <[log in to unmask]>
> Subject: BRAC-1 gene
>
> Hello from Sunny South Florida,
>
> As usual I am stumped and looking to the wise ones here...
> I have a mother who has BRAC-1 gene mutation. She has MRI's yearly. She
> is currently breastfeeding baby number four. She breastfed her other
> children for a year each. She has been told by her oncologist that she
> should only breastfeed for 6 months. She doesn't know why. Does anyone
> have experience w this?
> Thanks in advance,
>
> Polly Westra RN, IBCLC
>
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> ------------------------------
>
> Date: Tue, 10 May 2016 11:24:47 -0500
> From: Pat Young <[log in to unmask]>
> Subject: Re: BRAC-1 gene
>
> Breastfeeding protects vs br Ca so I can't imagine why shorter is
> better. I wanted to say 'because he is a jerk' but I'll restrain myself
> and say instead ask him for has proof. Maybe a study has come out to
> enlighten us all :-b and ask for a second opinion from another oncologist
> :-) Pat in SNJ
>
>
> ***********************************************
>
> Date: Tue, 10 May 2016 13:30:30 -0400
> From: Esther Reich <[log in to unmask]>
> Subject: Breastfeeding and breast surgery
>
> PTP. A close friend of mine is being worked up for breast cancer right now.
> She is 35 years old and is currently breastfeeding her 11mo daughter. At
> her appointment for the biopsy (of the breast mass and swollen lymph node),
> the surgeon advised her to wean in preparation for surgery. Based on her
> ultrasound results, the mass is highly suspicious of cancer, which is why
> the surgeon was preparing her for the likelihood of surgery. The biopsy
> results will be back in about a week and if positive for cancer, she will
> get genetic testing and an MRI. If the genetic tests reveal BRCA 1 or 2,
> she will be advised to get a double mastectomy.
>
> My question is this: if she does NOT end up needing a double mastectomy, is
> it ok for her to just wean from the affected breast and continue
> breastfeeding from the unaffected breast? I realize that if she has to get
> chemo, she will no longer be able to breastfeed.
>
> I would appreciate any feedback or anticipatory guidance that I could give
> my friend. We are all in shock about the possibility of cancer and she is
> feeling very sad about having to wean her daughter sooner than she wanted
> to. Her daughter is sick right now and is wanting to comfort nurse a lot,
> so it is feeling especially hard to try to wean her. Do you think she has
> to do this? Is it ok for her to wait for the bx results? Or would surgery
> likely happen soon after the results, giving her less time to wean? Does
> she have to wean from the unaffected breast? What should she expect in
> terms of how soon she would go home (ie., how many days' worth of milk she
> should have stored up for baby while they are apart). I don't have
> experience with this kind of thing, so would appreciate hearing from those
> of you who do and how I can best support my friend in this.
>
> Thank you,
>
> Esther Reich, RN, BSN, CLC
>
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