"Close" margin after mastectomy?

3girls4me

Hi all!

Well I'm back from my oncologist appointment.   I had bilateral mast w/recon 3 weeks ago.  This was my "formal" go-over-the-plan appointment with oncologist.   He basically said no further treatment because all was stage 0 and non-invasive.   Yay!  SO happy about that!   And my prophylactic breast had an area of borderline DCIS!  (Scary that none of this showed on my mammogram or ultrasound).  But, in reading the pathology report when I got home, I saw that one margin was less than 1.5 mm.   I know the "ideal" margins are a controversy.   When I talked to my surgeon about this, he wasn't concerned and said they get all the breast tissue possible.   But I'm just worry-warting here and wondering maybe I need radiation???  that would really mess up my re-con at this point. 

Anyone else know anything about close margins after you've had mastectomy?   I can't find anything else online.

Thanks!

Leslie

purplehaze66

Leslie congrats on the good news.... I had a mast with 1 mm close margin. I did have chemo and rads. I had 3 nodes+ I did my rads after my reconstruction with out any adverse reactions. good luck to you!! Michele

Motherbeartosix

I think that margin is ok from what I've read here.



Good luck!

Beesie

Leslie, congratulations on the good pathology report!

As for the close margins, I understand your surgeon's position on why he's not recommending radiation.  This is because the close margins were on DCIS.  After a mastectomy, there is a very significant difference between having close margins on IDC vs. having close margins on DCIS.

As my surgeon explained it, after a mastectomy, no matter how well the surgeon scrapes, there likely will always be a tiny amount of breast tissue left up against the chest wall and the skin (in the case of a skin sparing mastectomy).  IDC exists within breast tissue, so if there are close margins on IDC, radiation is necessary to kill any IDC cells that might remain.  DCIS however only exists within the milk ducts; DCIS cancer cells have not moved into the breast tissue.  So while some breast tissue will remain after a mastectomy, it's highly unlikely that any milk ducts will remain.  The recurrence risk after a mastectomy for DCIS is only about 1%; this is why most surgeons don't worry about close margins on DCIS after a mastectomy and why radiation usually isn't prescribed. 

My closest margin on DCIS was 1mm.  Radiation was not recommended and neither my surgeon, PS, nor oncologist raised any concern.  I'm almost 2 years out; so far, so good! 

3girls4me

Thank you for your replies!   I feel better...

BEESIE- Great information.....thank you so much!   I sent you a PM, not sure if it went thru.  But I highly respect your advice and information.....I see a lot of your posts to people, and you are very knowledgeable.   What was your recommended follow-up treatment?  My onc saying no mammograms, but I've heard of people who do get them after recon.

Thanks again!

Leslie

Gulfwater

Some place I've read that a one cell margin is enough, but more IS better.  I had a lumpectomy for DCIS.  One margin was very narrow -- 0.1 mm.!!  How is that even measured???  Because of that and because the tumor was kinda large (4 CMs), I had rads.  I'm five years out and fine today.

Mary D.

Beesie

Leslie,

Nope, I didn't get the PM.   My follow-up treatment was 6 month manual checks by the surgeon on my reconstructed breast, and mammograms (and ultrasounds if necessary) on my remaining breast, which are reviewed by the surgeon.  After a year, I graduated to annual checks - my next one is coming up soon.  If anything seems to be problematic with my reconstructed breast, the plan would be to have an MRI.  No mammograms though.  I can't imagine how the implant could be squished in the mammogram machine!

Mary, that was a narrow margin!  I don't know what would have been recommended if you'd had a mastectomy but certainly in the case of a lumpectomy it makes sense that you were sent for radiation since, unlike mastectomy patients, you still have milk ducts in your breast, which means that there is a place where some DCIS could still have been hiding.  I suppose for lumpectomy patients, the question of whether a re-excision is necessary to get wider margins may depend on whether one's DCIS is scattered or well contained.  If it's well contained, a narrow margin, along with radiation, is probably fine.  But if it's scattered - mine was spread out like fine sand all over my breast - then I'd guess that most surgeons would want to go back in to get wider margins.  That does seem to be the case with most of the DCIS women here who've had lumpectomies. 

Gulfwater

Beesie, it was just one large tumor.  The words on the path report I love most:

No invasive carcinoma present. 

Other basic info on the report:

Solid DCIS / Cribriform DCIS

Necrosis - Absent

Stage Grouping - Stage 0

If ya gotta have it, I'm happy enough with all that stuff.

Mary D.

Beesie

Mary, I'm with you on that!  None of us want the diagnosis, but if you've got it, there's nothing better than the pathology report you had.  It's particularly good that your DCIS was all in one tumor.  Mine was all over the place - it looked like someone had thrown fine sand on my mammogram film.  Still, I consider myself lucky that with all the high grade DCIS I had, I ended up with only a 1mm microinvasion.  Funny how our perspective of what's 'good' changes once we've been diagnosed.

  

I saw your other post mentioning that your annual mammogram is coming up tomorrow. Mine is in a few weeks.... fingers crossed that all we both need are basic mammograms with no call-backs and then we're done for another year!  Good luck!

Nancybc

Hi , can you please help me understanding following:Tumor Size: Two foci, 1.5 cm and 1.4 cm in greatest dimension



Margins of Excision:

Invasive Cancer: negative

Distance to Margin: Invasive carcinoma is present less than 0.1cm from the anterior inferior margin (lower outer quadrant) but additional margin is free

# Axillary Lymph Nodes Examined: six (6) Number of Positive Versus Total: zero

E. The specimen is received fresh, labeled with the patient's name and designated on the requisition as "left breast anterior margin overlying tumor," and consists of multiple fragments of fibroadipose tissue measuring 3 x 1.7 x 0.4 cm in aggregate. Thank u