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Topic: Got second opinion but can't decide.

Forum: DCIS (Ductal Carcinoma In Situ) — Just diagnosed, in treatment, or finished treatment for DCIS.

Posted on: Jun 26, 2007 04:09PM

rubysmom wrote:

My mom was diagnosed with DCIS back in May. She has had a lumpectomy and reexcision. Her margins were still positive after the reexcision. She went to a comprehensive cancer center and met with doctors to get a second opinion. They said she needs another reexcision to get clean margins. Now our concern is, should she let the general surgeon that did the first 2 surgeries do the surgery since he knows where to reexcise or go with the new breast surgeon. Our concern is, since he didn't do the other surgeries how will he know where to excise exactly. What if he excises the wrong tissue and tells us everythings ok. We just want to make sure we get all the cancer out and we are worriers. Has anyone gone through the same situation and let us know how it went for you.

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Jun 26, 2007 04:54PM Beesie wrote:

If your mother prefers to go with the breast specialist, I don't think there will be any problem. What you have to remember is that cancer cells are microscopic - even the first surgeon wouldn't be able to "see" where to operate and with all the surgeries that he does, it's unlikely that he'd remember exactly what area of tissue he removed last time. The way that either surgeon will know where to cut by analysing the mammogram, ultrasound and/or MRI films, and by reviewing the pathology report from the first surgery. In all likelihood, prior to surgery blue dye will be injected into the specific area that needs to be removed, with a mammogram used as a guide to highlight the right area. So whether it's the first surgeon or a new surgeon shouldn't make any difference.

As for the surgeon telling your mother that everything is okay, the only way he can do that is with a pathology report in hand. If the pathology report shows clean margins, then your mother is okay. If the margins aren't clean, then more surgery will be needed. This would be the same for either surgeon.

I did change from a general surgical oncologist to one who specialized in breast cancer after my excisional biopsy. I ended up needing to have a mastectomy because my cancer was too widespread to make a lumpectomy a viable choice, but if I'd had a lumpectomy, I wouldn't have been concerned about changing surgeons between operations.
“No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke
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Jun 26, 2007 06:17PM Chattypatti wrote:

Go with whoever she is most comfortable with. Either one still has to excise the area and get clean margins (or not). There is no way either surgeon can see cancer that small so they go with the operative report from when the tissue was removed the first time and go from there. Good luck.
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Jun 27, 2007 12:50AM roseg wrote:

It sounds like the first surgeon was pretty careful about not removing too much breast tissue if you've had two re-excisions without clear margins.

Does your Mom have cosmetic issues? If she has a small breast and somebody goes in to clear out the rest and takes a lot of tissue she may wish she'd had a mastectomy and reconstruction.

If she doesn't want to lose any more tissue than she has to for that reason then maybe the first guy is better because he's already been careful about not removing too much.

I think a breast center is going to want to do more, 'cause that's they're business. DCIS is serious, but not life threatening so she probably would do fine without a breast center.

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