Involved margins after MX

yasminv1

I posted this in the DCIS forum, but thought I would post here too since my dx has changed to IDC. My BS called me on Friday with after mastectomy path results. I had Bilat MX with TE placement on June 15th. I was originally dx with Multifocal DCIS after 3 biopsies on the left breast. The MX path report did not have great news. The area affected by cancer was larger than they had thought and they found 3 lesions each with small invasion. My BS did not give me too much detail as he wants to set up an appointment to discuss further in his office this week. He said he is still waiting on hormone receptor testing. His main concern is the cancer encompassed the entire upper inner quadrant and that he was not able to get clear margins. My SNB did come back negative. He is recommending another surgery to try to see if there is more tissue he can take out to see if he can get better margins. He also mentioned radiation. My question is, How much tissue can be left after a skin sparing mastectomy? How common is it to have second surgery after MX? I am hoping when I get a copy of my path report tomorrow that it will make more sense to me. I plan to request an appointment with a medical oncologist and radiation oncologist to get their opinions on what the new treatment plans should be. My BS has not mentioned speaking to any oncologist.

Yasmin

ddlatt

i think your situation is not unusual. my tumor was 1mm from the chest wall, and the surgeon got only 1mm margin during surgery. the pathologists at the tumor board and my medical oncologist at UCSF felt that i needed 2mm to have truly clear margins, so i had the option of having additional surgery or having radiation (and chemo). my surgeon said "a millimeter is a mile to a surgeon". i chose chemo and radiation because i had grade 3 cancer, triple negative, and i wanted to be very aggressive against a chest wall tumor. i was told they leave 2% of breast tissue intact after surgery (impossible to take it all) and that's why the cancer can recur in that area. i'm glad to hear you are consulting with a med and rad oncologist. i found that my surgeon had very different opinions from my oncologists and really oncology is not her forte. 

yasminv1

ddlatt,

Thanks for sharing your experience. I think the next step is to see an oncologist and go over the report with him/her. At this point I haven't even seen my path report so I don't even know what Grade I even am and the details on the margins.

Thanks!

Yasmin