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Feb 24, 2013 11:22AM
LesIsMore, I've had 3 excisional biopsies. Each was different. That's because there are no standards for something like this. The surgeon has to evaluate the specifics of the individual case and go from there. Two different surgeons looking at the same case may choose to do it differently.
As MelissaDallas said, generally it's not the surgeon's goal with an excisional biopsy to achieve good margins. With ADH there is about an 80% chance that the patient does not have breast cancer, and most surgeons would agree with you that they don't want to do a big operation and remove too much breast tissue when the most likely result is that there is no cancer. So normally the surgeon will try to remove all the suspicious tissue, but not much more. In some cases, however, if someone is large breasted and the area of concern is small, the surgeon might make a judgement call that removing a bit more breast tissue won't impact the appearance of the breast and so he or she might take out more in an attempt to get good margins. As for how much extra would be taken... again, that depends on the surgeon and the size of the breast. While 10mm is an ideal margin, 2mm is an acceptable margin; even when operating on a known cancer, many surgeons will not go for 10mm margins on women who are small breasted.
In my case, I'm small breasted and I had two areas of calcifications. The needle biopsy had found ADH in one area and wasn't able to reach the other areas. When I went for my excisional biopsy, my surgeon tried to remove all the suspicious tissue in both areas, without removing any excess breast tissue. It was still a lot of breast tissue that came out. And as it turns out, I had DCIS in both areas and a microinvasion of IDC in one area, and no clean margins. With DCIS, it sometimes happens that not all the cancer shows on a mammogram, particularly for women who have extremely dense breasts, as I do. So you're right that the surgeon is operating blind; the calcifications are microscopic and impossible to see with the naked eye, and if there is cancer present, that too is impossible to see. And the other potential problem is that the imaging might not be fully accurate. This is why it's not uncommon to end up with 'dirty' margins after surgery, even when the surgeon is attempting to deliver good margins.
So to net it all out, there are no standards to the size or shape of the what will be removed. It depends on the size and shape of the lesion, and to some extent, the size of your breast (since a surgeon will be more likely to attempt margins during an excisional biopsy if someone is large breasted). Whether or not your breast is deformed depends on how much is removed and how large your breast is; with an excisional biopsy usually surgeons will try to remove enough tissue but no more than necessary so the impact on the appearance of the breast is minimized.
In your particular case, the good news is that with such a small area of calcs - only about 5mm - the likelihood of finding DCIS or IDC is probably lower than the 20% average - and in all likelihood not much breast tissue will need to be removed. So there's not much, if any, impact on the appearance of your breast.
Good luck with the surgery!
Dx 9/15/05, DCIS-MI, 6cm+ Gr3 DCIS w/IDC microinvasion, Stage IA, 0/3 nodes, ER+/PR- “No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke