Three Surgeries for this type of cancer

kkaur

I turned 50 and was diagnosed with DCIS in early june and do not clearly remember if I was given a choice between lumpectomy and masectomy. A nurse showed me some implants and gave me some brochures. A general surgeon gave me a date for a lumpectomy. I had that done on July 01 and was given my reports the following week. The margins were not clear and I was given another date Aug 11 for an excision. I had that done. The results were shown to me after a week and the margins were still not clear hence I have to now go through a third surgery. This time the surgeon gave me the two options and I cannot make a decision. Has anyone gone through three surgeries? Is this a normal course? Should I do another excision and save my breast and go through radiation and five years medicine( my cancer is estrogen and progesterone receptive) or have it removed even though the cancer is non invasive and not malignant.

almagetty

Hi kkaur! Although I'm sorry you have to be here, too, welcome to the board.

I'm 47 years old and was diagnosed in March. I also had a lumpectomy with a "dirty margin" and a re-excision that failed to get a sufficiently clean margin. For me, another excision was not possible, since the margin that was "close" was right at the nipple, which my surgeon explained meant that the DCIS could easily have then travelled along another duct and into another part of my breast. Also, a lot of tissue had already been taken in the two previous surgeries and , cosmetically, I wouldn't have been left with a anything that really resembled a breast. Every case is different though, and there are ladies who have had a successful third lumpectomy. Your breast surgeon should be able to give you a recommendation one way or another, even if he/she leaves the final decision to you. My breast surgeon told me that with the minimal margin that I did have at the nipple (less than 1mm), choosing radiation and tamoxifen instead of a mastectomy would give me an unacceptably high risk of recurrence. She told me that if it was her and she had the same pathology report, she would choose a mastectomy without question.

All that being said, choosing to have a mastectomy is not an easy choice. I consulted with my oncologist, my radiation oncologist and two plastic surgeons before coming to the very difficult decision (for me) to have a unilateral mastectomy. I have had my skin-sparing mastectomy with tissue expander placement for reconstruction. The final pathology report showed that my decision to have the mastectomy was definitely the right one, since they found extensive DCIS branching our from the nipple into another quadrant. I've finished the whole expansion process and just had my surgery to exchange the expander for my permanent implant. I still have one more surgery to go to  reconstruct my nipple, which couldn't be saved because of the close margin there.

Just one tidbit that I wish I had been told before (or that I had known to ask about) ... if you have a unilateral mastectomy like I did, there is a good chance that your oncologist will still recommend that you take five years of Tamoxifen to help prevent cancer from developing in your other breast. Talk to your oncologist about this beforehand, so that you know going in what you are facing down the road. There is also a chance, depending on where your dirty margin is, that you may still need radiation after mastectomy. Discuss the chances of this with your radiation oncologist or your surgeon. 

Like I said before, every single case is different, and what was the right decision for me may very well not be the right one for you. But, in answer to your question on whether a third surgery is normal, it does happen.

Good luck! 

Kitchenwitch

Kkaur, I am facing a very similar situation. Had what everyone thought was a 6- or 7-mm spot of DCIS and another spot, less than 1 cm, that was suspicious so was biopsied at the lumpectomy. The second spot turned out to be DCIS, and the margins were not clear (not sure which spot) so I asked for an MRI (inconclusive) to see if the amount of DCIS would be any more specific.

 My breast surgeon seemed to feel that a second re-excision was an option, but I'm on the fence and shopping for another doctor. A pathologist reviewed my slides and felt they indicated a significant amount of remaining lesion, and that a mastectomy was unavoidable. (However, he never asked my bra size and I have really, really big breasts.)

I can see the upside to mastectomy: in most cases, no radiation. So I've been thinking I might do that. There are many, many reconstruction options. But I guess I still hope to keep my breast and do radiation.

I would seek  second and third opinions, if I were you. It's amazing how doctors can have pretty different outlooks. Your grade is not high, and DCIS is generally thought to be slow growing, so you can take some time to weigh your options and learn as much as you feel necessary.

Best wishes! 

Mommy-M

I am grappling with the similar question...a re-excision or masectomy. Tonight I am leaning toward masectomy because it seems to me that going through radiation, however localized, will cause my body more overall harm than removing a breast. But who knows, I may change my mind tomorrow.

mom3band1g

mommy - m - remember that even with a mast you could end up with radiation.  Remving a breast is MAJOR.  I know it is a very personal decision but if I could have kept my breast I would have in a heartbeat.  It's not a simple surgery and the ramifications are forever.  Good luck.

Kitchenwitch

Mommy-m and Mom3band1g - Right there with you. I go back and forth daily (doctor appointments are not till next week and then another one on Sept 15, aargh) and at the moment I'm inclined to try to preserve a body part. I would really hate to have the mastectomy and have to have radiation anyway. 

Roberta2

Not trying to scare anyone because each of our situation are 100% different.

My case, 2003 three surgeries to remove DCIS--no clear margins after third surgery...went for a second opinion with another surgeon and he said that my first sugeon went above the call of duty...which he meant that if it was him, he would have only done surgery twice but felt my surgeon was doing all he could to save my breasts. 

I had no rads, chemo, tamoxifen..just checkup with surgeon for the last 7 years.  Choose to do double masectomy  because the non cancer breast had previous benign tumors.

Fast forward to 2010--I found lump in April...after numerous tests including fine needle and core biopsies (which one showed cancer and the other did not) had lump removed and YES DCIS with Invasive Ductal...they are not sure if recurrence or new breast cancer in the same breast..

Now doing chemo, rads, and tamoxifen.

My point, is everyone is individualized and so is there cancer..there is no two that are the same, no one has the same lifestyle...You have to do what is the correct thing for you and what you are comfortable with...

Am I sorry I choose double...no!  Do I feel that I should have chemo/rads...no!  because based on my pathology reports, etc. the first time, this was as early as possible, etc. and no chemo and rads was the protocol at the time.