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Sep 13, 2020 10:29AM
muska, I am as confused as you about the measurement. Is it possible that the area of calcifications they saw before surgery covered an area of 5cm, but the actual DCIS material they took out was 8mm in total? I am not sure. It is something I will be asking my surgeon tomorrow. I don't know which measurement is more important for prognosis (Beesie?). The reconstruction I had was oncoplastic reduction and lift. Due to the wide incision needed on my right breast, and the fact that I was around a D cup, my BS suggested that I was a good candidate for reduction/lift at the same time to balance the breasts. I saw it as a nice perk (pun intended).
Minus, I initially had your concerns about the HER2+ but reread Beesie's excellent DCIS posts and figured out that it wasn't relevant. However, my high grade ER-PR- does majorly play into my decision. If it was low grade or ER/PR positive I don't think I'd be as concerned about the small margin.
What they are basically saying is that with DCIS, 2mm margins are required, but if you are having rads and there is only minimal involvement near the margins, well, that might be okay then. To me that doesn't sound overwhelming positive, particularly with grade 3 DCIS. I've been hanging around here long enough to have seen quite a few recurrences after close margins with grade 3 DCIS; many of those recurrences have been invasive cancer, and a few had progressed to mets. That's not to scare you, but from my experience here, I'd say that close margins on grade 3 DCIS is not something to play around with. And the fix is easy. Lots of people have re-excision surgeries; they are usually quick and easy and then the margin concern is eliminated. I also think in your case, because your DCIS is ER-/PR-, you won't be taking endocrine therapy, which reduces recurrence risk by 50%. Without that in your toolbox, it's even more important to ensure that you have adequate surgical margins.
Beesie, your comment above puts into words exactly what my initial reaction was. I am definitely leaning toward this option but will hear what my surgeon has to say and talk to the radiologist too. Given that I am relatively healthy and tolerated the first surgery pretty well, I think I could handle a re excision. But again I will have to gather a bit more info.
Thanks again ladies! I tend to be someone who thinks things over privately but this message board has been a great support and resource for me during this crazy time.
7/14/2020, DCIS, Right, <1cm, Stage 0, Grade 3, ER-/PR-
9/4/2020 Lumpectomy: Right; Reconstruction (left); Reconstruction (right)