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Topic: Insufficient margins after mastectomy

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

Posted on: Jun 12, 2017 12:44PM - edited Jun 12, 2017 12:45PM by aquilegia

aquilegia wrote:

I recently had a unilateral mastectomy with DIEP reconstruction. The pathology found DCIS (high grade, comedo) all the way to the bottom of the breast, with a clear margin of < 1 mm. I haven't talked to the general surgeon who did the mastectomy, but the PS says that they try to remove all breast ductal tissue. Since there's really nothing more to be done (I've already had radiation, so can't repeat it), and I'll be going on AIs anyway, my impression is that this isn't something to be very concerned about.

Has anyone else had this situation, and what was the recommendation for future monitoring or treatment?

Dx 1996, DCIS, Right, <1cm, Stage 0, Grade 2 Surgery 4/8/1996 Lumpectomy: Right Dx 1998, LCIS/DCIS, Right, <1cm, Stage 0, Grade 3 Surgery 2/10/1998 Lumpectomy: Right Dx 12/23/2016, DCIS, Right, <1cm, Stage 0, Grade 2, ER+/PR+ Surgery 2/16/2017 Lumpectomy: Right Dx 2/21/2017, DCIS, Right, 5cm, Stage 0, Grade 3, ER+/PR+ Surgery 6/1/2017 Mastectomy: Right; Reconstruction (right): DIEP flap
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Jun 12, 2017 03:31PM Allabtbirds wrote:

My situation is somewhat similar. Had bmx and diep flap recon last May. Path report indicated intermediate DCIS and positive margin. Apparently very small area of DCIS remains in lower outer quadrant of breast. Fortunately no invasive was found. Drs are not recommending another surgery to remove tissue (given small size and reconstruction) nor do they recommend radiation. They are recommending I take Tamoxifen for 5 yrs. Medical team explained research doesn't support radiation or another surgery for such a small amount of DCIS. I don't understand how any DCIS remains if ducts were removed. I see another oncologist tomorrow for a 2nd opinion.

Positive margin after mx. Drs recommend taking Tamoxifen for 5 yrs but I'm on the fence. Dx 1/10/2017, DCIS, Left, 6cm+, Stage 0, Grade 2, 0/1 nodes, ER+/PR+ Surgery 5/16/2017 Mastectomy: Left, Right; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Jun 12, 2017 07:24PM LAstar wrote:

I had a <1mm superior (skin side) margin with my MX. I was very concerned but my BS said that MX margins are very different from LX margins. I needed to have another surgery for reconstruction, so they look more of the skin around the area where the margin was so small but nothing further was found.

Dx 3/5/2012, DCIS, 6cm+, Stage 0, Grade 3, 0/3 nodes, ER+/PR- Surgery 4/6/2012 Lumpectomy: Left Surgery 5/4/2012 Lumpectomy: Left Surgery 6/19/2012 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): SGAP flap/hip flap; Reconstruction (right): SGAP flap/hip flap Surgery 10/5/2012 Reconstruction (left): SGAP flap/hip flap; Reconstruction (right): SGAP flap/hip flap Surgery 1/26/2015 Reconstruction (left): DIEP flap
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Jun 14, 2017 09:15PM Allabtbirds wrote:

Hi LAstar,

Happy to hear you had a clear margin! Did your dr recommend taking Tamoxifen? Thanks

Positive margin after mx. Drs recommend taking Tamoxifen for 5 yrs but I'm on the fence. Dx 1/10/2017, DCIS, Left, 6cm+, Stage 0, Grade 2, 0/1 nodes, ER+/PR+ Surgery 5/16/2017 Mastectomy: Left, Right; Reconstruction (left): DIEP flap; Reconstruction (right): DIEP flap Hormonal Therapy Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Jun 15, 2017 02:32PM LAstar wrote:

No, I had bilateral MX so it was not recommended. So far, so good (knock, knock).

Dx 3/5/2012, DCIS, 6cm+, Stage 0, Grade 3, 0/3 nodes, ER+/PR- Surgery 4/6/2012 Lumpectomy: Left Surgery 5/4/2012 Lumpectomy: Left Surgery 6/19/2012 Mastectomy: Left; Prophylactic mastectomy: Right; Reconstruction (left): SGAP flap/hip flap; Reconstruction (right): SGAP flap/hip flap Surgery 10/5/2012 Reconstruction (left): SGAP flap/hip flap; Reconstruction (right): SGAP flap/hip flap Surgery 1/26/2015 Reconstruction (left): DIEP flap

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