Decisions
Hi - new here - my yearly mammogram this year was inconclusive, so I returned for additional imaging and an ultrasound, which led to a biopsy, which led to a diagnosis of infiltrating ductal carcinoma. All this took about a month. It is a stage I and small (5mm) tumor. I know I need surgery - either lumpectomy w/ radiation or mastectomy. How do I choose???? If I chose mastectomy, I’d want both breasts removed. But if that’s the case, do I want reconstructive surgery or not? At the initial surgeon visit I was told lumpectomy surgery could be 1 1/2 to 2 hrs, but total mastectomy w/ reconstruction could be 6-10 hrs, as the plastic surgeon would be there too. Isn’t it dangerous to be under anesthesia for so long? Also, we live about 1 1/2 hrs from the hospital so having radiation 5x/wk for 2,3,4 (?) wks would be a hardship. I’m feeling so confused and indecisive, but I have to chose soon. Anyone have a lumpectomy that they regret? Anyone having total mastectomy with regrets? Anyone having a total mastectomy without reconstruction have regrets? I’d love to hear from you.
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If you are older than 50 you would be eligible for a shortened radiation protocol. The FAST protocol involves one day of radiation for five weeks. IThe FAST-forward regimen has five consecutive days of radiation. Both are just as effective in 50+ year old women as the standard three week course of radiation. It may be possible for you to have brachytherapy where the radiation is done with the surgery. You should ask to speak with a radiation oncologist to see what your options are.
I had a lumpectomy with three weeks of radiation since I had a positive node. My hospital is a three hour trip each way. It was during Covid so I was teaching online. I was able to stay at a hospital owned hostel fairly inexpensively and made two round trips each week. Mastectomy would involve less traveling but has a much longer recovery (three to six weeks off work) so I figured I would have ended out missing the same amount of work if I weren’t teaching remotely
I would suggest deciding what you would prefer if the distance were not a factor and seeing if you can make it work. Your choice of surgery will affect you for the rest of your life. Reconstruction can be either implants or tissue flaps, a more extensive surgery. I opted for less surgery and keeping one intact breast but other women want to avoid radiation. Some women are fine with implants but others want reconstruction using their own body tissue. My hairdresser is happily flat having opted for a double mastectomy since she carries the BRCA1 gene. It’s very much a personal preference. Research the details of the various options before you decide. All the best.
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Hi! Tough decision for sure! I had high grade DCIS 5cm involving nipple so I chose BMX w reconstruction. On path 1.3 mm single focus invasive tumor was found. My only options were single mastectomy or double. I went w double and implants w 3D nipple tattoos. Though I'm happy with the cosmetic results, I think if given option of lumpectomy with radiation I would have seriously considered that.
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Your decision might hinge on other factors, such as the location, receptor/HER2 status, & grade of the tumor; and the size of the breast.
Nearly 10 years ago at almost 65, I had a Stage IA, ER+/PR+/HER2- Grade 2 IDC that was 7mm on ultrasound, 9mm at biopsy and 1.3 cm at surgery (exactly 1 month after mammogram/ultrasound). It was explained to me (via charts & studies) that with cancers such as mine, the chance of recurrence with lumpectomy vs. mastectomy was identical—and only very slightly reduced with bilateral mastectomy. I had large breasts (still do), and my tumor was located on the upper outer aspect ("10:00" position) with no nipple involvement; so the lumpectomy with sentinel lymph node biopsy (nodes were negative) did not materially reduce the size nor affect the shape of that breast (which was the smaller one anyway). With a bra on, one couldn't tell they weren't the same size. I've opted not to reduce the healthy breast—I've had more than enough surgeries in my lifetime.
I opted for lumpectomy with the possibility of later reducing the healhy breast for symmetry (which Medicare covers). At the time, the standard radiation protocol was whole breast, 35 sessions over 5 weeks daily M-F (with the last few sessions being higher-intensity). But my radiation oncologist informed me of a study in which he participated, where postmenopausal women >65 had identical recurrence risk with the 3DCRT protocol—16 double strength doses daily M-F, just one day longer than 3 weeks, and just to the "tumor bed" rather than the whole breast. I had minimal skin effects beyond temporary reddening. I was able to drive the third night post-op (and went out to dinner the night after the surgery).
By contrast, my BFF, at 70, had Grade 3 DCIS multifocally (several small tumors scattered in both breasts). She was flat enough to have ditched her bra 30 years earlier, so she opted for a bilateral mastectomy without reconstruction. She required more pain meds than I did, needed two nights as an inpatient (mine was ambulatory outpatient, home by dinner time), and had to deal with dangling & emptying surgical drains for over a week. Only upside was being able to skip radiation. We both skipped chemo too.
How things have changed! New research has shown that for Stage I hormone-positive/HER2-neg., postmenopausal women >65 can safely skip sentinel node biopsy if node status can be determined by imaging pre-lumpectomy. That speeds recovery time and makes recovery less painful. And as Maggie15 noted above, the new radiation protocol (for women as young as 50) is even shorter: "FAST," one session a week for 5 weeks, or "FAST-forward," 5 consecutive days and then done.
And if you don't have either family history or one of the known mutations (such as the BRCAs or CHEK2), the chance of even contralateral (opposite breast) recurrence is infinitesimal.
It all boils down to age, how you view your body and what if any visible changes to it you're willing to accept.
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Hello. I had br ca years back in 2005, and at that time it was all about Drs definitely recommending lumpectomy/ rads as opposed to mastectomy or BMX, if at all possible. Well, I am grateful for all, but if I had to do it again I would have done the BMX then that no one really recommended to me. I had DCI Grade Two at 9 mm. It was in my right breast which was the smaller breast. The biggest emotional issue I had is when I went off the Femara after 10 years ,and I was so very afraid. My mom has also had br ca but it wasn't genetic based for either of us. Anyway, it caused extreme amounts of anxiety and even tried to change Drs to get more surveillance, and it was just tough in North Fl to get drs to do the MRI alternating after the mammogram every 6 months. Even the newer Dr would only do mammogram twice a year for me, but still no MRI which was unusual compared to oncologists in South FL.
I eventually went back to my long time Dr I had for years, chose not to have BMX although I did consider it with my Dr I went back to. Then only since I lost my husband two years ago, my Dr has allowed me to get the MRI alternating. (I also have medium density breasts.) I could have gone back in and had both removed still and recon. but it's a lot of surgery. Anyway, for me, I truly wish I had just done it originally . I was already going through a lot so may as well have. I think emotionally it would have lessened my anxiety when I had to come off the hormonal blocker after 10 years. Plus, now as older the smaller breast requires a small prosthetic as my body has changed now as a 61 year old. Before I didn't need it so now it is a way of life that I'm trying to get used to again .otherwise I'm noticeable crooked. Anyway, just my experience. We are all different and I hope the best for you no matter your choice!
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hi I was just diagnosed a few weeks ago also. I did have surgery and had two small tumors removed one was micro IDC and one was 4 mm IDC ER positive HERS2 + I was told with lumpectomy ,hormone therapy and radiation. The risk factors for reoccurrence were the same as a total mastectomy. My biggest worry has been the HERS2 + and Grade 3. What I have been told the protocol is chemo and HERS2 treatment are done together .I may be able to get HERS2 treatment with a trial. I need to learn more about this to see what the drugs are what the dangers side effects are and if I could end up with a placebo? So many questions at a very stressful time !
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I am 58 and was just diagnosed in June with two sights of estrogen positive invasive ductal carcinoma in right breast. Invasive ductal carcinoma, grade 1-2, 0.6 cm in greatest linear extent. Intermediate grade ductal carcinoma in situ, solid pattern. Invasive ductal carcinoma, grade 2, measuring 7 mm in longest dimension. Mammogram did not catch it but NP in breast surgeon office during routine visit found a lump at 7:00 just below nipple. Surgeon recommended lumpectomy followed by radiation then hormone therapy when it was just one sight. Would not know definitively of lymph node involvement until after lumpectomy. After ultrasound guided biopsy and then an MRI guided biopsy to check out an area of enhancement which found the second sight. Leaning towards double lumpectomy with radiation. Even after the second sight was found. It was also recommended to see a plastic surgeon (which i did) to discuss mastectomy with reconstruction which I really don't want to do but know unless absolutely necessary. I want to have the least intrusive surgery which would probably include losing my nipple and may cause my breast to be much smaller but I can live with that. It's my body and I get to choose but it is such a tough decision and I want to make sure I am making a smart decision. That said, I want to be able to get back to my active life and back to work, yoga, travel and fun with my family and put this behind me. Any advice would be appreciated. Thank you.
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Hi @yogi1967, I was lucky to have my lumpectomy done by a breast surgeon with training in oncoplastic techniques. She used tissue flaps inside my breast to rearrange things to preserve the shape and size of my breast. I had only one site of IDC but it was 3.2 cm. She said she would do a nip/tuck on the other breast to make them perfectly symmetrical but I didn't bother with that since there was hardly any difference. The recovery was easy, the same as any lumpectomy. I don't know if there is a breast surgeon with that training near you but it is worth investigating or traveling a bit. I hope your surgery goes well.
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Hi @yogi1967, and welcome to Breastcancer.org! We're so very sorry for the reasons that bring you here, but we're really glad you've found us. As you can already see, our amazing community is full of incredible members always willing to offer advice, information, encouragement, and support — we're all here for you!
Surgery decisions can be so difficult, but ultimately the decision is yours. We're sure others will be by soon to weigh in with their experiences, but in the meantime, we wanted to share this page on Mastectomy Vs. Lumpectomy with you. As well, we have a helpful thread here that discusses the pros and cons of these decisions that you might find insightful:
Here is also some information on oncoplastic lumpectomy that @maggie15 mentioned.
We hope this helps. Please let us know what other questions you might have and what decision you've made. We're here to support you through your surgery and beyond!
—The Mods
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Thank you so much! This is so helpful.
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