Topic: lumpectomy vs mastectomy - why did you choose your route?

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

Posted on: Jun 13, 2013 01:54PM

Posted on: Jun 13, 2013 01:54PM

ealga wrote:

Hi all, 

i was wondering if anyone could elaborate on this question. i have multifocal, grade 3 DCIS, and am contemplating another lumpectomy vs a mastectomy. my surgeon is confident she can clear the margins with another lumpectomy, and recommends radiation afterward.  BUT anecdotally, so many women I’ve talked to, even with a Grade 1 single foci lesion, opted for mastectomy.   I don’t want to undertreat OR overtreat but I am struggling to figure out why women would make this choice and what am I missing?  I'm at a very cutting edge cancer hospital if that matters.  I'd love any perspective on this.  Many thanks in advance. 

Dx 4/4/2013, DCIS, 5cm, Stage 0, Grade 3, 0/0 nodes, ER+/PR-, HER2- Surgery 5/15/2013 Lumpectomy: Right Surgery 7/10/2013 Lumpectomy: Right Radiation Therapy 8/28/2013 Breast Dx 9/23/2020, IDC, Right, 2cm, Stage IIA, Grade 3, 0/3 nodes, ER+/PR+, HER2- Surgery 11/7/2020 Lymph node removal: Right, Sentinel, Underarm/Axillary; Mastectomy: Left, Right; Prophylactic mastectomy: Left; Reconstruction (left): Tissue expander placement; Reconstruction (right): Latissimus dorsi flap, Tissue expander placement Chemotherapy 1/5/2021 CMF
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Jan 28, 2014 11:57PM KLJ wrote:

Bluewillows, I wasn't offered an MRI after having a mammogram that showed something suspicious. It was recommended that I have a follow-up mammo in 6 months. I wasn't satisfied with that and demanded am MRI. Funny thing is my MRI showed cancer in the other breast not the "suspicious" breast. The surgeon that I am now seeing said that she feels that every woman should have MRI's not just mammograms. Had I not demanded the MRI I still would not know that I am walking around with cancer in me. And now I am on the road of getting rid of it! So anything that makes someone aware of an MRI being an option is a good thing. I can't count how many people I have told "if they see something suspicious demand an MRI".

You cannot control what happens to you, but you can control your attitude toward what happens to you, and in that, you will be mastering change rather than allowing it to master you. Dx 12/12/2013, DCIS, ER+/PR+ Dx 12/12/2013, IDC, <1cm, Grade 1, ER+/PR+, HER2- Surgery 3/17/2014 Mastectomy: Left; Prophylactic mastectomy: Right Surgery 3/17/2014 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy 6/19/2014 Femara (letrozole) Surgery 9/2/2014 Reconstruction (left); Reconstruction (right)
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Jan 29, 2014 01:07AM icebaby10 wrote:

Lumpectomy

Dx 10/2/2013, DCIS, Stage 0, Grade 2, 0/0 nodes, ER+/PR+, HER2+ Surgery 10/29/2013 Lumpectomy: Right Radiation Therapy 12/9/2013 Breast Hormonal Therapy 2/1/2014
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Feb 13, 2014 10:04PM motherofone wrote:

Hello all,

   I'm new to this and just finding threads that apply to my situation.  What wonderful sources of information you all are.  I've been diagnosed with DCIS.  I wasn't given the numerical detail many of you know, but she did say stage 0.  I've been to two surgeons and have selected the one we will use.  The suggestion is lumpectomy, radiation, tamoxefin.  I have small breasts and understand that a lumpectomy will take out quite a chuck, so my husband and I are seeing a plastic surgeon on Tuesday to select the best course of action.  If I do mastectomy, I do not have to do radiation.  Can't sleep at night over this decision.  I know we need to make ti next week and schedule surgery.  Never thought I was that attached to my breasts until this. I'm feeling guilty about everything.  Guilty that I'm being such a wimp about something that is curable and guilty that I'm even concerned about what my body looks like after this ordeal.

   I've only read the first page of this thread.  I've got lots more to read, but I thought I'd share my situation.

   Thank you.

Dx 1/31/2013, DCIS w/microinvasion <1mm, Grade ?, 0/1 nodes, ER+/PR, HER2+ >3 Surgery 3/13/2014 Lumpectomy: Left Surgery 3/27/2014 Lymph node removal: Left, Sentinel Radiation Therapy 4/21/2014 Breast Targeted Therapy 5/7/2014 Herceptin (trastuzumab) Hormonal Therapy
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Feb 13, 2014 10:41PM bluewillowskys wrote:

KLJ...talked to my onco and she said i could stagger mammo with MRI...i just had mammo last week but really want and MRI NOW not 6 months from now. I emailed her office saying such but havent heard back yet.

motherofone....sorry you are now part of the group, but know we are here for you. You are NOT a wimp...even women with DCIS are warriors in pink ! we have difficult decisions to make too. If you are thinking of getting an implant you will want to skip the radiatin route...it a higher risk for complications to try putting in an implant after rads. My PS just told me that because of my rads after my lumpectomy for DCIS. Had i been told that prior to my lumpectomy i would have opted for MX instead....

Yippy Skippy ! Dx 4/7/2011, DCIS, Right, 1cm, Stage 0, Grade 1, 0/0 nodes, ER+/PR+ Radiation Therapy 6/1/2011 Breast Hormonal Therapy 8/1/2011
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Feb 13, 2014 10:50PM beesie.is.out-of-office wrote:

motherofone,

Sorry that you have to be here, but I'm glad that you've found us.

If you decide that you really would prefer to have a mastectomy, then go for it.  But don't feel that you 'should' do it, or that it's a better treatment.  It's not.  If your doctors have told you that a lumpectomy + rads is available to you as a treatment option, then it is a reasonable option for you.  

A mastectomy has lifelong implications.  It's not something to do because you think you 'should'.  And if you are considering having a MX mostly for cosmetic reasons - because of your concern that the appearance of your breast affected by the surgery - consider that a reconstructed breast has no natural feeling, and an implant reconstructed breast has no natural movement (although because the implant is behind the pec muscle, a reconstructed breast can have some pretty unnatural movements).  Before you make a decision to have a MX for cosmetic reasons, take a look a pictures of reconstruction, and not just the perfect pictures that a plastic surgeon might show you. 

Here are some pictures that are posted on breastcancer. org: Pictures of Breast Reconstruction

And here is another site with pictures: Breast Reconstruction Pictures

If you do decide that you want to have a mastectomy, do your homework so that you know what to expect, and what the potential problems might be.  Hopefully things go well but you don't want to be surprised if you do encounter any of the common problems or side effects / after effects.

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Feb 13, 2014 11:06PM tb90 wrote:

Motherofone:  I have noticed that quite a few women who opt for a lumpectomy have to have another surgery in order to get clear margins and some have to go on to have a mastectomy after two surgeries do not get clear margins.  It may help you with your decision to ask the surgeon (also given that you said you have small breasts), how confident s/he is of getting clear margins based on the size of the area to be removed, location in the breast, etc.  My breast surgeon believed that due to my small breasts and large area of DCIS, that a mx would be best and I still did not get clear margins (but this is very unusual).  So I am having radiation.  Having a mx is not a guarantee  of no radiation.  Your surgeon is obviously recommending a lumpectomy, so likely believes that there is a good chance of success with this choice, but it may help to have this discussion anyway.  These decisions are overwhelming at this point, but as you gather more knowledge and ask more questions, hopefully the right decision for you will become apparent.   

Dx 11/28/2013, DCIS, Grade 2 Surgery 12/18/2013 Mastectomy; Mastectomy (Left) Radiation Therapy 2/20/2014 Breast
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Feb 13, 2014 11:24PM beesie.is.out-of-office wrote:

TB90, that's a really good point.  It's important to know, heading into a lumpectomy, that in about 20% of cases, clear margins aren't achieved with the first surgery.  If that happens, a second surgery will be necessary, either a re-excision (another lumpectomy) or a MX.  It's also important to know that rads might be recommended even after a MX, if the margins are close (and for those who have invasive cancer, for other reasons as well, such as the size of the area of invasive cancer and the number of positive nodes).

It's also important to know, in choosing between a lumpectomy and a MX, that a MX with reconstruction usually means at least 2 surgeries, and sometimes 3 or even 4.  I believe that about 30% of reconstruction patients require revision surgery. 

motherofone, do you have a copy of the mammogram report and the pathology report from the biopsy?  Those reports will have important information about your cancer that can help you with your decision. Have the surgeons you've talked to given you an estimate of the size of the cancer?  Do you know if you have DCIS in just one area (a single focus) or more than one area (multi-focal)? And have you had an MRI?  After a diagnosis of DCIS, an MRI can help provide an estimate of the size of the area of DCIS - and this is a big factor in whether a lumpectomy is likely to result in clear margins.

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Feb 13, 2014 11:55PM KLJ wrote:

Bluewillowskys,

Don't take no for an answer! Keep after them!

You cannot control what happens to you, but you can control your attitude toward what happens to you, and in that, you will be mastering change rather than allowing it to master you. Dx 12/12/2013, DCIS, ER+/PR+ Dx 12/12/2013, IDC, <1cm, Grade 1, ER+/PR+, HER2- Surgery 3/17/2014 Mastectomy: Left; Prophylactic mastectomy: Right Surgery 3/17/2014 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): Tissue expander placement; Reconstruction (right): Tissue expander placement Hormonal Therapy 6/19/2014 Femara (letrozole) Surgery 9/2/2014 Reconstruction (left); Reconstruction (right)
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Feb 14, 2014 05:38AM sandcastle wrote:

Motherofone....MOST important.....listen to yourself.....don't let people confuse YOU.....you have wonderful support....and that is YOUR husband...Liz

Surgery 12/9/2010 Lymph node removal: Left, Underarm/Axillary; Mastectomy: Left Dx DCIS, Stage 0, Grade 2, 0/4 nodes, ER+/PR+, HER2-
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Feb 14, 2014 07:55AM faerywings wrote:

Hi motherofone!

I am in the same joy-filled boat as you ;) DCIS, small breasted (barely an A even now!) with a lumpectomy scheduled for March 3. My BS said that if they can't get clear margins the first time, I would only be "eligible" for one more try, just b/c there isn't that much breast tissue to take.

My BS said that in her experience, only 1 in 10 need to go back for a second surgery so I am hoping that i am in the 9 that does not. I wish I knew (maybe I don't!!!LOL) how much of a lump they are going to take. She mentioned that I could see a PS afterward but also said that prob only hubby and I would see any difference. 

Sometimes it is so hard to do, but I know all that I *can* do is take a deep breath and keep on going fwd.

good luck to you!

"No Day But Today" ~Rent Dx 1/17/2014, DCIS, Stage 0, Grade 1, ER+/PR+ Surgery 3/3/2014 Lumpectomy: Right Radiation Therapy 4/7/2014 Breast

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