Something I still wonder: Can't they remove an entire duct?

CrunchyPoodleMama

Okay, I should know this by now, but I haven't found an answer to this.

Pure DCIS remains within milk ducts.

By my logic, if there is DCIS within a duct, it is reasonable to expect that some DCIS could be present throughout that duct.

Why, then, do DCIS lumpectomies apparently aim to remove a nebulous round/oval-shaped area (based on microcalcifications) and not specifically removing the entire affected duct(s)?

Just something I had wondered a while back and even moreso now that I'm having a mastectomy in a couple of weeks......

And hey, while I'm asking random questions, here's another one: Let's say a woman has ducts that are severed through lumpectomy or biopsy. She then gets pregnant. Her body starts manufacturing milk... what happens to that milk in the severed ducts? Does it somehow drain into the breast or get reabsorbed?

The reason I ask is that when a woman has a late-term miscarriage, it can cause changes within the ducts because the body isn't set up to gear up for milk then stop, without a way for it to flow out of the breast. (Multiple miscarriages, at least three, before first live birth, is a breast cancer risk.) I'm wondering if the same risk is posed when the duct is severed at some point without a way for milk to flow out naturally.

Beesie

Why, then, do DCIS lumpectomies apparently aim to remove a nebulous round/oval-shaped area (based on microcalcifications) and not specifically removing the entire affected duct(s)?

Think of the milk ducts in your breast like a bowl of spaghetti.  Or bucatini, actually, since the ducts are hollow.  They are all intertwined together.  So pulling out just one would be impossible.  And because they are intertwined, often DCIS cancer cells will move from one duct to another.  That's why DCIS presents either as linear calcifications or as clustered calcifications.  Clusters of calcs are actually more common.   So the only way to remove all of the affect duct(s) is with a mastectomy.

I don't know the answer to your 2nd question.

Hindsfeet

Interesting question. My 2nd b.c. surgeon stapled my ducts on the side where the cancer was removed. Ever heard of stabling ducts so that they don't travel through other ducts?

mjh69

That is interesting.  I have often wondered about the whole ductal connectivity thing. I had 4 babies and breastfed all.  Everyone of them preferred my left breast, although I bfed from both.   Turned out I ended up with DCIS in right breast.  MRI and Mammo showed only one spot of concern but in final pathology after BMX the slides showed two non consecutive slides with DCIS, one 2mm and one 4mm...I believe it was all one duct, but who knows - one was obviously undetected...scary. 

 If there was a way to remove just one long intertwined duct, that sure would be interesting.  My DCIS presented with only a few calcifications-nothing worrisome...I had the option of waiting 6 months or biopsy.  I chose biopsy, the rest is now history. I am 41 with no family history of BC.  I can say that BMX procedure was not as bad as it sounds and I am so glad to have had it done. I have my final exchange surgery this week. Can't wait to get it all over with.

 Good luck with your MX!  I wish you health and happiness.

CrunchyPoodleMama

This is interesting and raising even more questions for me. Are they interconnected all throughout each other all throughout the breast? My extensive DCIS is exclusively (and well within) two adjacent quadrants. I'm thinking of asking my surgeon if he can do a HALF-mastectomy... leaving ducts on the clear side available to breast-feed. (I'm hoping for twins and it surely would be convenient to still have two breasts able to breast-feed, even if to a limited extent!)

Barry, I'd never heard of duct-stapling! Veddy veddy interesting... 'tis a dangerous thing when I have a whole brand new thing to Google... heh he