Lumpectomy vs. Mastectomy
Dear all, I was diagnosed 2 months ago and I am getting anxious about not having had surgery yet, but I am still confused. I have a IDC, estrogen and progesterone positive and Her2 negative. Around 11mm. Ki65 of 5%. They had to do 3 additional biopsies but they all turned benign. I am 45. I have dense breast, which are harder to follow and functional radiological tests are needed (MRI). Since I only have a small tumor, lumpectomy was offered first but they also would accept a mastectomy if I want to. My thinking was: I am having a lumpectomy and then mastectomy if I want when I am ready or need it. But this argument was ruined when I learned that lumpectomy goes with radiotherapy and radiotherapy hurts your skin and prevents or limits certain reconstructive options. Therefore, if i ever want or need mastectomy with reconstruction, I will likely have to opt for the one done with your own tissue, which apparently is way more complicated. I am unsure about mastectomy because I am not familiar with its side effects, the way reconstruction feels and looks, etc. Doctors in Spain seem to tend to do lumpectomy when possible. I am worried about doing lumpectomy and then having another tumor and having a complicated mastectomy/ reconstruction experience. Any insights are welcome! Cheers to all
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I'm from the school of less is best if possible. This gives you a chance to have other treatment down the line if need be. I had a lumpectomy, chemo and rads in 2011. My breasts have looked great for the past 14 years and I had never regretted having the lumpectomy. Of course with that surgery, I had my mammos every years and many scares in the first few years.
Now my ER+ has come back and it is multi-focal. There are at least 2 tumors and it is a local recurrence. I cannot have radiation again so lumpectomy is out. Of course at this point the mastectomy was offered. I want symmetry and I do not want to be following up with mammos any more. I'm lucky I didn't have a metastasis since statistically there was more of a chance of that than a local recurrence. So, in 3 weeks I will have a DMX. Because I want reconstruction and the failure rate of implants is high with radiated breasts, I am having DIEP surgery.
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I opted for lumpectomy and radiation in 2008 - DCIS. No chemo. I took tamoxifen for 3 years, until the fatigue was too much. All was well until this year - 16 years later. I just had a BIRAD 5 ultrasound 1.2 cm spiculated mass. I will have a biopsy on Dec 17. I also have a MOHS surgery for basal skin cancer on my nose on December 19 - that is also a recurrence. I am 68 and will opt for a single mastectomy at this point. I think…….I will put off the decision on reconstruction as the nose issue may required more than one surgery. Im a bit of a mess…..but pushing forward!
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I had a BMX in 2009 when diagnosed with IDC in my left breast. I did this in part because I had very small breasts and a lumpectomy would not look good with so much, of what little I had, removed. So, in order to have symmetry, I chose to have BMX. (A single mastectomy would've been difficult to match with the other side. They don't make implants that small! 😁) Anyway, it was the right decision for me. And, although I had clear margins, I did have radiation (due to location close to chest wall) once the expanders had been completely expanded! It seems that everyone has slightly different options based on very personal factors and diagnosis. Best of luck in your decision, @rockym.
Pam
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@isasana You may have already made your decision and if so I hope you are on your way to healing! I wanted to share my experience as I struggled a lot with lumpectomy versus mastectomy. I ended up going with a bi-lateral mastectomy with implants and am happy with my decision. I was diagnosed with high grade DCIS, left breast, 2.5 cm, multifocal in Nov 2024. The lumpectomy would have been complicated given such a large area of DCIS but it was doable. I have dense breast tissue. Since dense breast tissue is at higher risk for BC, I decided that it would be best to get rid of as much breast tissue as possible to prevent a contralateral breast cancer down the line in my other breast. I was lucky to have a really good and reputable plastic surgeon who did a great job with the reconstruction (implants). I think the plastic surgeon is key. I'm a bit of an anxious, low-risk person, so for me the bi-lateral mastectomy gave me peace of mind. I was okay giving up my natural breasts since I'm 55 and their best days were behind them. They had served their purpose. Best wishes to you wherever you are at in your process.
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