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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Jun 13, 2013 11:24PM ej01 wrote:

I had a single, very small bit of high grade DCIS, and I chose lumpectomy+partial breast rads.  I carefully considered all of my options.  At one point in my decision process my emotions took over and I thought the best thing to do (as a mother of a young child) was to make sure I am there for my child in the long term and 'cut them both off'.   i also saw a mastectomy as less obtrusive than taking tamoxofin, which has a huge list of known side effects...and maybe other unknown ones. (I hate taking any sort of medicine/drug.) After research, i realized that having a mastectomy was not as simple as having a boob job...there were a lot of potential long term discomforts.  I also looked at my relatively low recurrance rate and decided the best thing for me was a lumpectomy (without Tamox).  If i have a recurrance, i have no doubt that I will have a mastectomy.

Good luck whatever you decide.  Both of the BS that I talked to were OK with either mast. or lump.   What is right for me (or anyone else on this board) might not be right for you.

Dx 7/26/2011, DCIS, <1cm, Stage 0, Grade 3, ER+/PR+
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Jun 14, 2013 07:20AM Nancyinct wrote:

I had a large area of high grade DCIS removed via lumpectomy on June 5th and expect to start radiation in about 3 weeks. I had very large breasts so the option for a lumpectomy for an area 13cm was still a viable option for me. I had a reduction on the other side so they would match. Many people simply panic and just want the cancer out of their body and choose mastectomy, single or double, some, don't want to or don't have close access to a hospital that does the radiation, while others cannot fathom chemotherapy. Everyone is different. The important thing to remember is that you have to live with your decision. And you should be comfortable and at peace with your decision. I opted for a lumpectomy. I am waiting for the pathology results. If this doesn't work, I will have new options to consider. The same person with the same family history and diagnosis might have chosen a different treatment option, but for me, this was worth a try and even if it doesn't work out like I am hoping it will, I still am comfortable and at peace with my decision. Good luck with your decision(s).

Dx 4/5/2013, DCIS, Right, 6cm+, Stage 0, Grade 3, 0/1 nodes, ER-/PR-, HER2- Surgery 6/5/2013 Lumpectomy: Right Dx 6/17/2013, IDC, Right, <1cm, Stage IA, Grade 3, 0/1 nodes, ER-/PR- Dx 6/17/2013, IDC, Right, <1cm, Stage IA, Grade 3, 0/1 nodes, ER-/PR- Dx 6/17/2013, IDC, Right, <1cm, Stage IA, Grade 3, 0/1 nodes, ER-/PR-, HER2- Surgery 7/23/2013 Lymph node removal: Right, Sentinel; Mastectomy: Right; Reconstruction (right) Dx 8/2/2013, DCIS, Right, 1cm, Stage 0, Grade 3, 0/1 nodes, ER-/PR-
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Jun 14, 2013 11:36AM ealga wrote:

A warm hello to all of you.  I am sitting here all teared up, not only at your thoughtful and incredibly insightful replies, but also that you've all been through this emotional wringer.  I am going to re-read all of your posts now (lately it takes me so much longer to process things - is this normal?!?)  

I have a meeting with my surgeon this afternoon. My leaning at the moment is to try for another lumpectomy and see where we're at, and I know that's what my surgeon wants to attempt as well. I may regret this decision, or I may not, who knows? 

Beesie - your information is invaluable, thank you.  I had no idea how unclear the path can be for DCIS. My first impression was that they cut it out and you're done! How wrong i was.  Sending you all my gratitude, and healthy peaceful vibes. 

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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Jun 14, 2013 01:22PM deb1973 wrote:

I honestly think Beesie's guideposts & focusing on what is best for you will lead you to the best result.

Everyone comes with a different set of factors informing their decision that are very personal & multi- faceted.

I had BMX. Is it a decision that was right for me? My gut says yes. Is it right for everyone? Of course not.

My decision was based on my doctors' advice (including a second opinion) about a huge amount of ER negative, premenopausal, aggressive grade DCIS in a relatively small breast.

I'd also had previous biopsies & calcifications in the other breast & an overall family history of very aggressive cancer, not just breast cancer. I have at least one family member who went the lumpectomy route with DCIS & recurred within a year with invasive breast cancer.

There are so many factors that went into my decision. My best advice is to take a deep breath & make the most informed, thoughtful decision you can. Every woman who comes on these boards has a tough decision to make. I did not take my choice lightly & I honestly do not regret the choice. Do I regret the circumstances of that choice? Perhaps, but I am still grateful that (unlike others who are diagnosed at a metastatic stage of cancer) that I had more options available.

Best of luck in both your decision & treatment!

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Jun 14, 2013 01:34PM proudtospin wrote:

I had 3 lumpies till the docs gave the all clear.  I asked before the last one if I should do a mastectomy, my surgeon who has an excellent reputation said no, I can get it all!  She seems to have been right as it is now almost 5 years, yes I did rads and have been doing aromasin but no regrets.  I do have a lot of boobie to start with~~

I think Bessie gives great advise but go with your gut.  Best of luck

iris Dx 6/2008, DCIS, Stage 0, ER+ Dx 2/2017, Left, Stage IV, metastasized to bone/liver, Grade 3, 1/1 nodes, ER+, HER2+
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Jun 14, 2013 02:38PM Starak wrote:

Beesie, Thank you for your post.  I hope I can find it the next time the subject comes up again.  It really does hit on many/most of the questions we all need to ask ourselves when deciding which way we need to go.

Freed 'em when they tried to kill me. BMX, no recon, center dog ears removed, currently living flat but still tending an extensive foob and mx bra experimental farm in the back of the closet.
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Jul 9, 2013 09:45AM bjham wrote:

To Ealga, I've been wondering how you are doing?  Did you need a second lumpectomy or get clear margins.  As I posted earlier, I had to have a second and we got clear margins so I'm about to start radiation.  I'm ready to get on with it and I'm feeling very positive.

Dx 5/2013, DCIS, 4cm, Stage 0, Grade 3, 0/1 nodes, ER+, HER2- Surgery 6/7/2013 Lumpectomy: Left; Lymph node removal: Left, Sentinel Surgery 6/20/2013 Lumpectomy: Left Radiation Therapy 7/23/2013 Breast Hormonal Therapy 9/17/2013 Aromasin (exemestane)
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Jul 9, 2013 11:07AM ealga wrote:

Hi bjham! Congratulations on your margins - that is great news - what a relief. I go in tomorrow morning for my re-excision. My surgeon is pretty confident (but not totally) that she can get what she needs, so i'm very hopeful. I feel good about both my hospital and surgeon. She is an ace. 

She said something interesting to me when we were going back and forth about mast. vs. lump/radiation - I  was leaning toward mastectomy simply because i was terrified.  But she said that the lump-rads route is often considered as equally/even more agressively treating the cancer than mastectomy, because the radiation will hopefully kill whatever tiny cells are left, whereas with a mx there is still breast tissue left behind, and radiation is not optimal.  Either way, the survival rate is the same. I hope she can clear them. Good luck with your radiation - i'd love to stay in touch with you as we go down this road together :-) 

question for you: how was your recovery from re-excision? quicker than orig. surgery or the same? It took me awhile to feel back to normal after the first lump. and i hope it doesn't take that long this time.   And, are you planning on tamox? 

all the best to you. 

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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Jul 9, 2013 11:32AM ballet12 wrote:

Best of luck, ealga, on your lumpectomy re-excision.  I did it in three lumpies, but the first was done by another surgeon who didn't mark the margins, so the second surgery was done by visual guide and there was still a close margin.  By #3 I had wide margins.  So, it's even possible to do three and then rads. Some even do four, but it helps to have a large breast for that (I don't have that).

Surgery 7/27/2012 Lumpectomy: Right Dx 8/2012, DCIS, Right, 5cm, Stage 0, Grade 3, ER+/PR- Surgery 10/5/2012 Lumpectomy: Right Surgery 10/26/2012 Lumpectomy: Right Radiation Therapy 1/11/2013
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Jul 9, 2013 12:31PM ealga wrote:

thank you ballet12! i hope she is successful. 

I'll repeat my questions for you: how was your recovery from re-excision? quicker than orig. surgery or the same? It took me awhile to feel back to normal after the first lump. and i hope it doesn't take that long this time.   And, did you do tamox? 

thanks so much. 

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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