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Invasive Ductal Carcinoma

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collijr
collijr Member Posts: 16
edited June 2022 in Just Diagnosed

I was diagnosed in March. I am 53 years old with no history in the family. I am Pro+/Est+/HER2-. The mass is close to my nipple (@1:00/2.5 cm deep). It is 11mm in size. I'm having a tough time deciding between Lumpectomy/Radiation or Mastectomy. Also not sure about reconstruction or flat. There's so many decisions to be made. It's tough!

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  • sarahmaude
    sarahmaude Member Posts: 338
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    Hi collijr,

    I’m sorry you are having to make these kinds of decisions. I think that it’s important that you feel confident in your decision. My characteristics were similar to yours, I’m a four years older than you are. Also had a tumor at 1:00 near my nipple. I found a Breast Surgical Oncologist who did an oncoplastic lumpectomy at the end of March. I had some delays between diagnosis and surgery, so my tumor ended up being 4 cm upon removal. I started out with plenty of breast volume, so even with that, I look symmetrical in a bra, and I’m very happy with my results.

    I’m in chemotherapy now, and following that will have radiation. For me, I’m glad that my recovery from surgery was easy. I have full sensation throughout my breast and nipple.

    I know it’s hard to decide. I knew that overall survival is the same with either lumpectomy+radiation or mastectomy. If positive nodes are found in surgery, we may still end up with radiation, so I knew a mastectomy didn’t guarantee no rads. I was not keen on expanders and implants, and though I was strongly considering DIEP, I had a blood clot during diagnosis, so I wasn’t a candidate for that option. I am used to my hourglass figure, and simple flat just didn’t feel right to me.

    Other considerations are how you feel about post surgery screening. With a mastectomy, you won’t have mammography anymore, and with removal of all breast tissue, risk of local recurrence is low. I was okay with continuing my mammograms with ultrasound.

    What are your concerns that have you feeling stuck?

  • K-Gobby
    K-Gobby Member Posts: 144
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    Collier,

    I hope you have a breast surgeon and a medical oncogist. The Size of the tumor is something to cover. I have Brca2 as well, so my small size and 5.4cm tumor meant clear margins not good to save my breast.. Before I did the genetic test, I was told a lumpectmy would not work for me. Choices. First get your questions answered. I talked with my team. I asked what is done with those like me. Brca2, and small breast, large tumor.

    I also talked with my friend, who told me about this site. Real women and men walking through breast cancer. Like most. I never thought I would get it.

    More will respond, like Sarah maude, we all have a journey that meets in different places. I was 60 at diagnosis. Be good to your self. This is your life and your body.

  • cathy67
    cathy67 Member Posts: 411
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    collijr,

    Sorry that you are facing all these right now. Personally I studied ncnn guideline for my discussion with oncologist, it is also good to understand the treatment options.

  • salamandra
    salamandra Member Posts: 745
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    Here is a thread that may be helpful for you: https://community.breastcancer.org/forum/91/topics...

    It can be very hard if your gut isn't pushing you in a particular direction. When the doctors ok either way though, it's ok to go with your gut.

  • gladis
    gladis Member Posts: 43
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    I actually wanted (initially) to push for mastectomy. I'm small breasted and figured why bring these sad puppies to the dr over and over- I live far from medical help. (IDC 14mm left ER: Positive (Strong ALLRED 8/8 PR: Positive 7/8) HER Neg and Ki-67 HIGH and Luminal B :-(

    I'm almost 60, no history, no ...nothing. I found my lump-my last mammo was almost 3 years before (ty pandemic)

    My surgeon and husband were not on the same page.

    Diagnosed in March, an April surgery with complications ensued, I've not seen or heard from an oncologist (It's Canada )

    or my surgeon since April and am now wishing I'd of gone with my gut.

    Please, don't misunderstand -I am grateful for the lumpectomy.

    Yet -having that piece of mind and NOT having to drive these 'ladies' to the mainland for treatments etc

    and the prospect of HT for years

    (which helps only in about half the population with similar diagnosis at this stage and age)

    I understand you being torn.

    Trust your gut and good luck!!!!

    I'm rooting for you collijr :-)!!


  • collijr
    collijr Member Posts: 16
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    All of this information is very helpful. I have my pre-surgery meeting with the breast surgeon in a few weeks. During our first meeting she said either a lumpectomy or mastectomy was a choice. After speaking with two plastic surgeons they both recommended mastectomies. I feel like that may be their opinion because that's what they do! I'm not fond of the idea of radiation. Is it ever an option not to follow a lumpectomy with radiation? I'm concerned that the radiation may leave my small breast disfigured. I wasn't ever a person interested in breast implants. It was just never on my radar. The reconstruction seems like a big deal. I've asked to speak with the radiology oncologist because I have so many questions. The lump is on the left side. How does radiation affect the heart? What are the chances of disfiguration? It would be so much easier if I didn't have a choice. Right now I change my mind every other day. Just not sure what the "right" decision is.

  • rah2464
    rah2464 Member Posts: 1,192
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    Collijr yes it is a very hard decision you make in a relatively short period of time. I found it helpful to kind of list out my thoughts in order to assess my feelings better. My cancer was also on the left side but very deep into my chest wall so I was concerned about radiation effects. However, I also went into surgery for a mastectomy knowing that I might wind up with radiation anyway if they didn't get clear margins. I think your decision to have a discussion with radiologist will be very helpful for you. I wish you all the best as you decide and move forward.

  • ava55
    ava55 Member Posts: 42
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    I had an implant recon mx and honestly it was not painful, no bruising and very little scaring and feels like myself - can’t tell in a bra or bikini. I was back to work in three weeks and was delighted I went mx route as didn’t have to get radiation. I am on tamoxifen now for 5 years (as they removed 0.5 cm of Invasive IDC) but on a brand with no side effects.

    The worst part of this whole ordeal is waiting for results. I thought the surgery was way better than I had anticipated and re they are plastic surgeons so everything is extremely neat. It was such a relief to wake up to the same shape.

    For me I didn’t want to wonder if a lumpectomy would leave something behind and the onc advised mx so it was the only option really.


    Good luck

  • salamandra
    salamandra Member Posts: 745
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    Lumpectomy without radiation has such a higher chance of recurrence that doctors will not recommend it except, in some cases, for women in their 70s or older where it is thought to not have a life extending benefit.

    I was nervous about it first but based on my own research and doctors I trust, the evidence supporting radiation after lumpectomy is about as solid and reliable as medical evidence gets.

    It is frustrating that the long term risks of radiation therapy are based on older technology that was most likely not as safe as today's radiation tech, but that's the nature of longer term studies.

    The radiation oncologist is the expert on the dosage and how it can be delivered most safely. It's good that you've asked for a meeting with them. My understanding is that even for left side radiation, they have techniques and positions that help protect the heart.

    I am almost four years out from my radiation treatment after lumpectomy, and I don't see any cosmetic damage or disfigurement at all. I think that is pretty common.

    FWIW, I think for many of us, radiation is pretty easy. It's a hassle with the logistics, and there is often fatigue especially towards the end, but that's about it. From what I have read here, the women who struggle with it most usually are dealing with the psychological aspects of the constant undressing and medical interactions, often because of prior trauma.

    All that said, mastectomy can be a good choice for many women.

    When I was first diagnosed and assumed that I'd have to have a mastectomy, I also assumed I'd want reconstruction and that having the look of breasts would be better for me emotionally.

    Looking back now, if lumpectomy weren't an option, I do think that aesthetic mastectomy without reconstruction is the way I'd go. Reconstruction *is* a lot of hassle, risk, long term upkeep, a whole new set of things that can go wrong.

    It's impossible to be sure about a hypothetical, though, and I know that many women are very happy with their reconstruction and either found it a smooth process or found that the out come was worth it.

  • cathy67
    cathy67 Member Posts: 411
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    For radiation, I totally agreed that it is very easy, and at least for me, there was no long term side effects before and after, I got nausea and fatigue during those weeks, but compared to my pregnancy, all those just cakes. The skin will be reddened, but it will back to normal after that.


  • alicebastable
    alicebastable Member Posts: 1,946
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    My radiation was also almost four years ago, and all I got was some dark pink on my clavicle and dry skin elsewhere - all very temporary. They did a wider field and 33 sessions on me due to a micromet. If your nodes are clean, it should be fewer sessions. What helped me with the tedium of going every day was the pack of dollar lottery tickets my husband bought for me at the beginning! Scratch the date off the schedule, then scratch off the lottery ticket. It actually made it kind of fun in a crazy way. I had early morning sessions and since I don't drive, Hubby just shifted his schedule by a half hour or so thanks to FMLA. We'd usually drive through a park right after my session which helped tremendously with the mental part.


  • K-Gobby
    K-Gobby Member Posts: 144
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    I did not choose flat. Once I was told I could have a skin saving implant I went with it.

    I met with the Rad Dr to review radiation after my left mastectomy and expander. I was supposed to get radiation. In the end, he said my type is sbout 2%of the population. It might offer an extra 1-2% longer life. If I was his family, he said I would tell them not to do it. There are other treatments. He said the possible long term effects balance my benefit. I could still have done it.

    So chemo first, that stopped after 13 rounds due to blood troubles. I still will have radiation choices as I never had it as I said above.

    What I want to say is I always asked the doctors and women here and a couple friends with cancer. I did not scour the internet, which can drum up fear. I like what I have heard, that once your breasts are gone, they are gone. Find our the risk. What those with your numbers have had the best results with. Make your choice from there that feels right in your gut and heart, not head. Those voices up there need to be quiet.

    For me, I have the rt breast to come off and both implants in once my blood clot is clear. In 4 months, no problems with my expander. Being that it does not have my nipple, I know it is fake. It feels odd, but I know it is temporary.

    Please report back on your Dr visit and talk. I am here for you too.

  • rah2464
    rah2464 Member Posts: 1,192
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    Alice that hubby of yours is a keeper !

  • msphil
    msphil Member Posts: 185
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    hello sweetie we here know your feelings. I wanted to lift you up with my story Inspiration. This yr im a 28yr Survivor Praise God. I was diagnosed as we made 2nd marriages plans I found the lump in shower after 2nd opinion decided to go with mastectomy with reconstruction.. This yr is also Your 28th Wedding Anniversary.msphil idc stage2 0/3 nodes 3mo chemo before and after Lmast then got married then 7wks rads and 5yrs on Tamoxifen helped with no recurrence. Thank God. Positive thoughts and fiance then now husband family friends.. Keep Hope sweetheart.

  • alicebastable
    alicebastable Member Posts: 1,946
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    Rah2464, I've kept him for almost 40 years, so I agree!

  • msphil
    msphil Member Posts: 185
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    yes sweetie its tough decisions during this time im a long term Survivor Praise God and like to tell you some of my story for Inspiration wrote a book bout it but Not aloud to mention it. I was diagnosed while making plans our 2nd marriages at 42 with no history of breast cancer in family. Working in medical field in O R as Instrument tech then on City clinic had own office in medical records so when felt lump and discomfort under my arm in shower I know. Had biopsy diagnosed and 2nd opinion is wanted lumpectomy not to go into marriage without breast or reconstruction which I had bout body rejected Expanded as foreign object. So had removed and been living with prosthesis in bras now. Had 3 mo chemo before and after Lmast then got married then 7 wks rads and 5 yrs on Tamoxifen. Im now this yr a 28 yr Survivor. Praise God and we just had our 28 yr wedding Anniversary. Pray this helps. Hope Faith Family my dear Husband helped me thru. msphil idc 0/3 nodes .