Lumpectomy VS Masectomy?

sunflower71

Ok, it is now 2 days until my scheduled SNB and lumpectomy and I am doubting my decision.  Why do the surgeons leave it up to us sometimes?  I was told that because of the size of my breasts and tumor I could opt for a lumpectomy. But, my tumor is a Grade 3 and I don't know about node involvement.  I opted to do the conservation because chemo was in my future and I admit I am a wimp.  My thinking is, if my pathology comes back that it is in my nodes or the margins are not clear, then I will say take it off.  Did anyone else have the choice?  Which one did you opt for and why?  They told me my chances of recuurence are the same, why is that? So much doubt!!

Luah

Hi sunflower:  This is a very difficult decision to make, and the pro's and con's have been well debated on this forum.  You may want to do a search to see those earlier comments.  It's natural to have second thoughts (I know I did), but if your doctors have satisfied you with their answers, you probably know in your heart what you want to do, and should do it.  If they haven't, go back with your lingering questions.

One thing I will say about nodal status, however. Sometimes, nodes appear to be negative on clinical exam and even on scans, but they may come back microscopically positive on the pathology.  You can't know for sure in advance.  With positive nodes, you may have a reasonable expectation that cancer cells have moved beyond the breast (though they may also do so with presentation of negative nodes, and they may not with + ones, again nothing for certain) -- and systemic treatments like chemotherapy and hormonal therapy treat that risk.  Your surgical choice really has no bearing on that (i.e. a mastectomy wouldn't alter the risk).

Your doctors have probably advised you too that radiation is standard of care with lumpectomy; it may be recommended with mastectomy depending on your pathology and other factors.

NatureGrrl

Tough choices... My dx is similiar to yours.  My choices were slightly different, but in the end (after chemo, not before -- that was my first choice I had to make), I had to chose a lump. or mast.... I chose lump., even though my surgeon was recommending mast. first (but willing to do the lump.).

I chose lumpectomy for a couple of reasons:  one, why remove my breast if I didn't need to (and the prognosis was the same if margins came back clear); two, if the margins from the lumpectomy weren't clear, I could then do the mast.  It meant the possibility of two surgeries instead of one but I chose to go with less invasive first anyway.  My gut just told me it was the best way to go.

My margins and all lymph nodes, and ALL of the lump, were all clear.

Keep in mind this was a post-chemo surgery, so not the same as the situation you're in.  But still, I had to make a choice.  My decision was partly logical -- the reasons I listed above -- and partly it was what my gut told me to do.

It was my decision for my situation; everyone has to decide for themselves and their situation.  

My message is simply this: Gather information, ask questions, think about it, let it simmer on the back burner, and then listen to your heart/gut... if you need more time to feel more sure, ask for it... most of all, trust yourself.  You'll know what to do.