Incision location for lumpectomy
Have been diagnosed with DCIS, intermediate grade, under 1cm, Estrogen and Prog positive.. Been carefully researching, speaking with DCIS patients, interviewing Docs and have made my decision to have a lumpectomy, scheduled for March 8th... The area of DCIS was found on the 10 o'clock position on my left breast, on the outer edge of the breast, not close to the nipple at all.(calcifications/mammogram). Here are my questions:
1) One surgeon had recommended that the incision site be made at the outer edge of the areola. He said that it leaves the least scar... Has anyone heard of this before? What are the positive and negatives for this kind of incision... Are there better incision locations for the location of my DCIS (see above)? Thanks.
2) Been getting different opinions on how much margin they will be taking around the DCIS site. I know that the more clear margin the better prognosis... Bessie spoke about a 1mm clear margin having a very high rate of recurrence an ideal margin is 10mm in size. 10mm or greater lower recurrence... What size margin should the surgeon be taking out when he/she is doing the lumpectomy? Is there a set formula based upon the size of the DCIS sight? Thanks again for any feedback... One surgeon had told me that the Mayo Clinic defines a clear margin between 2 - 3 mm... How can that be clear if you really need 10mm for a lower recurrence? Help here?
Really appreciate all of the great information on the forums and hoping that i can be of help to those just recently diagnosed...
Thank you...
Comments
-
My incision was an arc along the outer edge of the areola. The scar is minimal and fades into the areola. If they can do it, that probably leaves the best result in appearance. My tumor was near the nipple so that incision was close to the tumor.
The breast consists of a number of separate branching structures that converge on the nipple. When they are doing a lumpectomy I think they usually remove the whole branching structure that contains the tumor even if the tumor is small and only in one location, because there is always the possibility of stray cancer cells having traveled through the ducts within that branching structure. That should mean they can use the areola incision approach regardless of whether the tumor is near to or far from the nipple.
The surgeon will try to balance taking out enough tissue for good margins vs. keeping the amount low enough to leave a good appearance. Especially with DCIS s/he cannot tell for sure how wide the margins are until after the pathologist examines the tissue. DCIS does not all show up visually or on imaging. The surgeon is using test results and experience to try to get the right balance on margins.
The size of the margins is related to recurrence risk but there is no magic number. Almost everyone agrees that less than 2 mm is too small and the risk of cancer remaining beyond the margin is too great. Some would say 3 mm. When people talk about ideal margins being 10 mm they are talking about taking a wide area around the tumor site. The area right around the tumor site is at highest risk of recurrence. If they can get 10 mm margins it may then be reasonable to consider skipping radiation therapy. The area of the breast beyond the 10 mm margins still has some recurrence risk but it is lower than that of the tumor site. The possibility of getting 10 mm margins depends on breast size. For small breasted women that may not leave much of a breast. For large breasted women that may mean the discrepancy in breast size makes breast reduction on the other side desirable.
You can get different opinions but most would agree:
a. margins less than 2-3 mm are not good enough
b. margins of at least 2-3 mm are good enough assuming you have radiation therapy
c. margins of at least 10 mm might be enough to consider skipping radiation (if you have only DCIS but it still depends on other factors)
0 -
Hi scorp1111
I just had my lumpectomy last Wednesday. My scar is at the 2 o'clock position vertical and in the areola. It should heal very nicely. Out of my 6 margins, 5 are perfect and one came back at 1mm. My doctor said that it is not good enough, so I am going in again next week for what is called a "re-excision." His plan is to take 4mm more and make it a 5mm margin, which he told me is the standard. The re-excision will take him between 5 and 10 minutes, so he is doing it under local. Aside from that, I can also offer that I haven't had much pain at all. The underarm where he took the nodes was the worst. I am a fast healer, but hopefully, it won't be terrible for you. Keep me posted
I am meeting my radiation oncologist tomorrow for the first time. I'm in for 5 weeks/5 days a week. 0 -
Scorp 1111,
location of incision!! Thanks for asking your question, because it forced me to go back and look for where I saw this mentioned. My DCIS was at 10 o'clock but closer to the nipple than yours - a Timex vs Big Ben?? Anyway, my incision is at the edge of the aerola, like you are describing. Therefore, when I read remarks about this type of incision in one of the abstracts placed on-line as part of the NIH Consensus Conference on DCIS in Sept 09 - I took note. Since you were diagnosed relatively recently you might not know about the conference or the wealth of info on DCIS it makes available to you. The conference is actually on-line, but more reasonably than listening to three days of doctors blabbing - there are abstracts and a final paper to read. http://consensus.nih.gov/2009/dcis.htm . The abstracts are available by clicking pdf next to the word abstract in the upper left. Anyway, on page 61 of the abstracts, in her paper "Local Control of DCIS Based on Tumor and Patient Characteristics, Lisa Newman, MD mentions " A long dissection tunnel from the skin to the site risks exposure of normal tissue to cancer cells." She goes on to say how this type of incision might cause problems if there is a need for re-excision. In my case, I hope my DCIS was close enough to the aerola so that a "dissection tunnel" was not created - in any event, I then received radiation and a boost. In retrospect, however, if the creation of a dissection tunnel to achieve a cosmetically pleasing result had been discussed with me, I would have said No thanks.
Note that you have been diagnosed with DCIS and Krissy with Stage 1. Krissy had nodes biopsied while that is not the norm when a lumpectomy is performed for DCIS. Hope your re-excision goes well Krissy! and good luck to you Scorp 1111
Julie E
0 -
Right!!! I have DCIS and IDC. Sorry if I scared you about the lymph node cut. You won't need that if you didn't have an invasion. I have a tiny invasion, which makes me Stage 1, even though it is close to stage 0. The difference was I HAD to have my lymph nodes checked, and you do not
Thanks for the luck Julie!!
I hope it goes well too...stupid 4mm!! UGH!! 0 -
Bumping this up because this was my question about my DCIS surgery. My DCIS was found waaaaay in the back near the chest well and the BS made the incision around the areola. I'm happy if the reason for is for reduced scarring. The core needle biopsy went in from the side and after 6 weeks, I still have a hematoma left over which I wonder if it will ever be absorbed.
0