Topic: lumpectomy vs. mastectomy?

Kira - this is one of the toughest decisions you can make. I'm so sorry you have to go through this! I too felt rushed - because I really wanted to get the cancer out. So much depends on the size of your breast tissue now.........I was a "barely B" and not to much in "love" with my breast, so I knew that a mastectomy would bring me much peace-of-mind, especially when my surgeon told me recurrence rates are MUCH lower with mastectomy than with lumpectomy/radiation. If you go for a lumpectomy you will need radiation - something that did not appeal to me, for many reasons. I felt that a mastectomy would "get it all" and I was willing to live with a prothesis. However, I was happily surprised to find out about the Diep reconstruction option which leaves very little scarring if done immediately after the mastectomy. So I had a unilateral skin-sparing mastectomy followed by an immediate Diep. I was home in 5 days and doing well - until I ended up back in the hospital because of a staph infection. The healing of my abdomen has been painfully slow, but I'm almost there now. If I didn't get that infection, I could have returned to work after 8 weeks.  I'm happy now that I went through it all......after my Stage 2 surgery my new "foob" will be hard to tell from the other "real" one.

The decision for a lumpectomy or a mastectomy is very personal and difficult - what you need to do is look closely at your pathology report, look at what kind of recurrence rate your cancer has, and see what you're comfortable doing. Since you have a wedding in just 4 weeks, perhaps you're better off doing the lumpectomy first and see if they can get clean margins. You can always opt for a mastectomy later - especially if they don't get clean margins, or if your lymph nodes show cancer, or your Her2 status is positive, or your Oncotype DX score is high......these tests all take time, but it helps you to decide on your treatment plan.

Good luck Kira - and stay in touch! We'd like to hear what you decide - AND to hear all about the wedding (did you get your gown yet?)

I do trust the breast surgeon, and there will be a tumor board decision: I am the one pushing for an earlier surgery date. At this point, she's left the options up to me, but will call after the tumor board meeting and with the additional imaging information.
I've read through the boards, because this question has come up before, and a lot of women chose mastectomy, and some chose the lumpectomy.
It is a personal decision, and I'll have more information in a few days.
Kira

Thank you for all the helpful comments--I felt this need to move immediately, and I do realize that I can put a halt to the process.
My husband is very concerned about radiation side effects--they concern me, but not as much, but I'm not thrilled with the possibility of lung and heart irritation.
The cancer is on my left side, and I'm left handed, and very left side focused--I really want to avoid lymphedema.
I have a whole day of MRI/ axillary ultrasound/ and a bone scan for some joint aches tomorrow.
I left the breast surgeon's office, and all these questions and doubts surfaced.
While I'm stuck in radiology tomorrow, I'll try and reach her to ask about the concerns: I understand the overall mortality is the same, but the side effects differ.
(I do have a dress, and I can stuff my bra if needed....)
Kira

Kira -- I know the first reaction we all have is to get out (I had my lumpectomy 6 days after dx). I can't say now whether or not I'd have done things differently, but I do wish I'd slowed down a little and researched things more. I had no idea radiation would limit treatment options if I needed a mastectomy later (which I did).

Does you doctor feel your surgery can't wait until after the wedding? I worry that you may not physically feel well in 4 weeks. Some people breeze through these surgeries and some do not, unfortunately we never know how it's going to turn out until afterward.

As someone said earlier, you can use the time prior to the wedding to research, get second opinions, have other tests, etc.  I think there are lots of women who have waited longer than 4 weeks for their surgery and it hasn't affected their outcome. The waiting is horrendous, I know, but it may be in your best interest so you can be in good shape for the wedding.

Good luck with the wedding. My daughter is getting married next March and I'm hoping to get my next surgery done this fall so I can be healed and ready. I'm currently healing from mast/tram on 4/2 and will be doing a lift on the other side in 3-4 months.

Don't know if this has helped you any, good luck with your decision. It's a tough one and everyone makes it for their own reasons. Stay in touch and let us know how you're doing.

Hugs

Hi Kira,

I was diagnosed in 2005 with lobular cancer Feb 2 and had a bilateral March 12.  The first surgeon I saw recommended lumpectomy with the required radiation.  I called back to schedule it, and said if the cancer came back I would want to have a mastectomy with immediate reconstruction.  She said that recon would be impossible after radiation.  That's when I realized I needed to research my options.

If you go through the surgery this week you probably will feel very sore for the wedding, lumpectomy or mastectomy.  Unfortunately, there is always the chance of complications.  But even if it is problem-free, I don't think many of us would have been able to hug hundreds of people, dance all night, and do the multi-tasking that is required of a bride's mom after our surgeries.

Also, there are women here who have had complications from trying to do too much too soon.  With a mast. you will have a tube draining the fluid out for at least a week, but even if it is a lumpectomy with sentinal node removal only, the tissues are cut, so you really can't lift anything or do any vigorous movement with your arm for awhile.  Many of us have had hematomas because we did.

I  think you will be happier waiting until after the wedding for your surgery.  We all want to forge ahead and rid our bodies of cancer and our minds of the worry, but first be happy at your daughter's wedding.

sally 

Hi Kira,

  What a Hard time to get your DX.  Here you are supposed to be enjoying the Before Wedding fun & Excitement.

I choose a Bilateral Mastectomy with Immediate Reconstruction...Except my Surgeon wasnt listening to me.  So I had a Lumpectomy with SNB to start with.   And will have my BLM next week.

Mine was also on my Left side and I worried about my Heart & Lung if I got Radiation.   (In hindsight that was good- because last week I found out  I have a hole in my heart.)

So a Lump. & then Mastectomy later can be done. (If your Next tests show that as an Option still) It is 2 surgeries ...You might feel More healed after just a Lump.   I cant say for sure...since I havent had a Mastectomy yet...But I think it will be more painful.

I felt pretty good from my Lumpectomy within a week.  The SNB took about 3 weeks to feel better.   4 weeks out I felt Well.

It is a Personal decision & Hard to decide sometimes...Especially when you have a shorter time frame.   And no one can tell you what to do.  They can only give you their Opinion.

Good Luck with your decision,

Pam

here's info for everything about reconstruction:

www.breastreconstruction.org

you can gets tips for before and after surgery- and see all the types of reconstruction.

I finally got some rest last night, which really helps. I am waiting to meet with the radiation oncologist tomorrow.
The surgeon did call last night, and was very kind, made clear her bias--mastectomy with reconstruction, and I haven't made it clear enough to her that I'm not interested in reconstruction at this point, or possibly in the future.
We're both doctors, and used to work together, which can make for an odd doctor/patient relationship.
I was the one to call the radiation oncologist, and plastic surgeon, and pull the doctor card to get some immediate information.
I told her that ironically, I trained in Pittsburgh with Bernie Fischer, the pioneer of breast conserving surgery. We discussed that there is sort of a bias toward breast conserving surgery right now--even the Mayo Clinic website sort of says, if your surgeon pushes mastectomy, consider another surgeon.
I realize that I'm being asked to make a decision before all the information can be available--I won't know the node status until post-op.
I'm meeting with the radiation oncologist for a consult with myself and my husband tomorrow.
Right at this moment, I'm strongly considering lumpectomy with SNB, and decide re: mastectomy after all the node status and need for chemo are available.
A truly informed decision can only be made when you have the entire picture.
Thank you for the site on reconstruction--it made me realize that I'm not interested in it at this point, and possibly ever, and I need to make that clear to the breast surgeon.
I have two days to rest and recover and process, and I thank everyone for their help and support.
My daughter and I both feel like the wedding is not the most important day of her life, a strong and wonderful marriage is the most important life. Her fiance is a wonderful person and has been in our lives for a long time. Ironically, he's also a physician, and sort feels like we need to talk "doctor talk".
No, I just need to be a patient.
Kira

kira here's another great site with info about not reconstructing:

www.breastfree.org

Keep us postesd on what you decide.

Hi Kira,

Well based on my experience I can only tell you that this is a tough one, my advice to you is dont rush your decision, think about carefully, because in my case I had a lumpectomy on 2/27, when the Dr. came back with no clear margins, I was devastated, I ran over to her and I could not stop crying, just thinking that I still had cancer in my breast, I ask the dr. to please schedule me for the next surgery that I just wanted to breast off, she continue to tell me that she could do a re-incisions and I could keep my breast, or if I really wanted a mastectomy to consider the reconstruction, I was not listening to her I just wanted the cancer out.  well I had the mastectomy on 3/18/08, no reconstruction, when they send my breast to the lab and the path report came back, there was no evidence of cancer. I was upset at the time, thinking that I could have save my breast, but then I  did felt comfortable with my decision due to the fact that my cancer was invasive, and now I am on chemo and I don't have to radiation.

I just wanted to share my experience with you.

Best of luck on your decision, and If you have any questions feel free.

A lot of women are going for mastectomies.  In Europe, 70% have lumpectomies, here in the US, the statistics are reversed.  I had a lumpectomy and I have been fine for 9 years.

One thing I hope everyone knows is that while there are many reasons for a mast, multi-focal disease, different things in the breast, DCIS plus IDC, etc., big tumor, small breast, etc., etc.  NEVER having to worry about breast cancer in that breast is not one of the reasons.  You can have a recurrence in the chest wall, the scar, etc.  Breast tissue is up your arm, under your arm, etc.  Can't all be removed.  So while a mast is often very, very necessary, never having to worry about that breast is not true, a mast just gives you a slight edge over lumpectomy.

Gentle hugs, Shirlann 

Yes, the risk of a local recurrence (same side) is twice as high with a lumpectomy/radiation as it is with mastectomy...but the overall survival rate is the same with either surgery.  I think it all evens out because a second occurrence on the lumpectomy side is supposed to be easy to find and treat.

I wasn't convinced of that, at least not in my lumpy-bumpy breast where the 1.8 cm IDC was never visible on a mammogram.  My GYN never did believe there was a tumor in there--at first, he couldn't feel it, and then he thought it was just fibrocystic tissue (in a 55-year-old, menopausal woman!).  So he never advised me to have any follow-up imaging when my mammogram(s) kept coming back "normal".

It was mainly my lack of confidence in my own ability to detect a recurrence that drove me to choose a mastectomy, despite the numbers I was quoted.  There were other, more personal reasons, as well.

otter

Well,
I had the lumpectomy with SNB on Friday: I chose local and IV sedation, and--?unfortunately--I was aware of a fair amount of what was going on.
Aware enough to remind them as I heard that they were going to hang a bag of ancef, that I'm allergic to it, it said so right on my red wrist band.
As the surgeon, who worked so hard to do a "good" job, thought she was waking me up, said--and she was all business in the OR--I'm just not happy with the way this looks.
And I opened my eyes, and said "But that's not what I care about, I care about seeing my grandchildren grow up, and living."
She was pretty upset about the level of my anesthesia--gave me her home #, told me she lives two blocks away and would make a house call if needed.
Overall, I'm doing okay. I was glad to be able to come that night, and recover in my own bed. The pain isn't bad, the inability to lift is hard to handle.
I did have the moment of truth with the first shower and looking at the site--it's less upsetting each day.
The recovery room nurse was a patient of mine, all through the experience I ran into patients and colleagues--so much for privacy.
The risk of local recurrence has been discussed: I found an article in the Journal of Clinical Oncology, from May 10, 2008 (pretty recent) and they found recurrence rates depended on receptor status-the lowest risk was ER+/PR+/Her---overall the local recurrence rate with lumpectomy/radiation was below 10% , but with the receptor status ER+/PR+/Hec-, it was 1.5 %. I met with the radiation oncologist, for a consult, in case that is the final outcome: she told me that the local recurrence is half that of a mastectomy, because even with a mastectomy there is breast tissue left behind--but the absolute numbers were still low.
She told me about a new protocol for quadrant irradiation, vs. total breast, and that by the time I'd be ready for radiation, I'll be 50, and eligible, and it looks promising. I have to decide if I'm willing to trade less radiation for a newer clinical protocol. Again, the goal is life here.
So, for me, the decision to move quickly with the lumpectomy and SNB ( she took 2 sentinel nodes, and one that was tucked between the two and didn't light up) was the right one for me.
I'm waiting to see her and get the pathology, node status, and find out what is the next step. That information will influence what the next decision will be.
I know the surgeon isn't happy with the cosmesis--aside from the bruising, it doesn't bother me.
I'm currently feeling better--tylenol is enough for pain--but tired and beat up (emotionally and otherwise). I missed my daughter's college commencement yesterday--she had graduated in December, but I urged her to go to the ceremony. But she come over afterward and they filmed the ceremony.
I thank you all for your thoughtful and supportive comments. And, I'll let you know what happens.
Kira
As the surgeon helped onto the table, she told me I made the right choice....

Just an update: had the lumpectomy under IV sedation last Friday, and was able to come home two hours after surgery.
The surgeon called yesterday, the day before our post-op visit today to say: tumor was 1.6 cm, (smaller than any imaging study showed) with some surrounding DCIS, she got clear margins and all three nodes are negative.
I'm scheduled to meet with radiation oncology and medical oncology, with the plan of radiation--whole breast or partial and tamoxifen.
I'm feeling tired, no real pain, just a sense of being "beat up".
For me, I needed to have the surgery, and I am glad I chose the lumpectomy at this point--my daughter's wedding is in a little over 2 weeks, and I have the surgery behind me, and the treatment in front of me, and they will send the oncogene dx.
Kira

Hi Kira:

All the very best to you
as you move forward

Nice to be a doctor and also
have this extra input from
your friends in the medical
arena

I just wanted to add:

My DX was year 2000
my lump was 3.5 cm..
Grade 3.. 1 node positive

I was offered both
but v. afraid to lose my breast
and of course went with the lump
chemo aggressive Tx
and rads

Now I am coming up .. to 9 yrs..
in 2009..

There is a big dent in my breast
I have small breasts and did not
want more surgery, just wanted to move ahead
I am older than you and some of the gals
in fact, I dont wear a bra now..
to heck with that, they bother me..

I would add: there were some who
said.. masectomy should have been chosen
for me, It always comes back etc.. however
we go with what is best for US

HUGS OUT TO YOU


Sierrs