Anyone had a second surgery?

Lovelyface

I had my first lumpectomy on July 28 for a 3.3 cm tumor.  The Pathology report indicates that I dont have clear margins after surgery, but have invasive ductal carcinoma to the 12-3 O' clock margin.  The second para reads "extensive ductal carcinoma in situ, intermediate to high grade extending to deep surgical margin in the 12-3 O' clock quadrant".  I think it means I have cancer in two places in the same left breast.

I am also getting my right breast checked, meaning the MRI showing one highlighted area, which will be biopsied on Thurs.

Surgeon says that she would like to preserve my breast and go in there and try to remove the rest of the cancer.  I haven't even seen my Oncologist yet, but was referred to a surgeon right after the biopsy.  I am seeing the Oncologist on Thursday morning, so will ask him about this second surgery.  The surgeon says if it doesn't take it all out this time, then it will have to be a mastectomy.  I don't really want a mastectomy.......please, I want to keep my original breast.

What do you ladies think?  Do you think it would be safe and possible for them to take it all out.  I did not have any cancer in the one lymph node she took out during the first surgery.  I don't have a date for the second surgery yet.  Also, should the surgeon have done intraoperative radiation during the first surgery?  She said she did not, and I am not sure why she did not.

Any input would be so appreciated.  Thanks.

dlb823

Lovelyface ~ Yes, you're going through what a lot of us have been through.  A lot of times -- and especially depending on the size of your bc and the size of your breast -- a surgeon can get everything by going back a 2nd time and sometimes even a 3rd for a wider margin.  But at some point, continuing to go that route may not yield acceptable cosmetic results, so a mastectomy with reconstruction becomes a better choice.  I fought for weeks to keep my breast.  In the end, I gave into the mastectomy and was glad I did based on additional bc that was found in my final pathology.  But if your surgeon is willing to try to re-do your lumpectomy and save your breast, let's just hope and pray that she will be able to do that.   In the mean time, one of the things that helped me to accept my surgeon's recommendation for a mast. was looking at photos of DIEP reconstruction (what my BS & PS suggested for me), and how wonderful and natural the results are.  Not that I'd ever recommend it if you can avoid it, but when I realized I wouldn't be entirely losing a breast -- just replacing diseased breast tissue with healthy tummy tissue -- that helped me to move forward.  

Good luck, and I will pray that your 2nd surgery for wider margins will be successful ~  Deanna

dlb823

Oops!  Uploaded 2X cause it was slow and I was impatient.

MrsNice

Hello Lovelyface (great name, by the way!),

Well, I've had 3 surgeries in a matter of 9 weeks.  First was to be a biopsy of a pretty large lump (over 5cm) which turned out to be B9, but during the same surgery some tissue (not a full "biopsy" per se) was removed that turned out to be IDC and DCIS.  A 2nd opinion, more films, and many weeks later, my new surgeon did a re-excision to get clear margins of the cancerous area, which resulted in losing my nip and lots of surrounding tissue.  Actual tumor there turned out to be 3cm with clear margins, but micromets of a sentinel node.  So, 3rd surgery, just a couple weeks ago, was for the axillary lymph node dissection (ALND) to determine if the micromets had gone any further.  Thankfully they hadn't.

Now, I started out with pretty large (DD) breasts, and didn't mind losing some size if necessary.  My main deciding factor was, "once you take it off, you can't put it back."  That's just my approach that I am comfortable with, understanding the risk that more surgery may be required if I get a recurrence.  I'd rather consider that if it comes up than lose a part of my body on the "what if" scenario.  Again, just my personal choice.  I've not decided on any reconstruction yet but am leaning toward not.  If I did any, it would be a reduction of my healthy breast so they match, but I may be just as content to wear a partial prostheses on the surgery side to balance it out. 

Please ask your surgeon to fully describe what the 12-3 o'clock quadrant involves; if it is a full quadrant that needs to be removed, then depending on your size that may or may not be an acceptable outcome. 

I encourage you to take the time to consider your options and make a decision that you are comfortable with.  You can PM me if you like, and I also have a blog that describes my journey so far.  www.kathyinwonderland.wordpress.com

Keep visiting here and let us know how you are doing.  This is a wonderful community of women (and a few men) who are very caring and supportive.

Lovelyface

Thanks to both you ladies, dlb823 and MrsNice.  Your comments really helped.  Yes, I have learned how real and beautiful the reconstruced ones look and eventually, if this second surgery doesn't work out, that decision would have to be made.  Yesterday I learned that I have tripple negative cancer, which only 15% of the women have.  It is hormone negative.  I am freaking out so badly, that there are just no words to describe.  Chemo is the only therapy for this.  Hormone therapy does not help at all.  I am going for a second opinion today and have requested that they present my case to the tumor board (a bunch of doctors who sit and look at cases) and make recommendations on treatment.  I think tripple negative tumors are the types whose cancer has shown in their breasts, but it could pop up anywhere, since they are not hormone receptive.  I am devastated.  They will be sending me for a petscan one of these days to see if it is anywhere else in the body as well.