How to decide...lumpectomy or masectomy?

somewhereinbetween

I will start by saying that it is truly a personal decision and one that should not be made alone. You can have all the information you want at your finger tips but ultimately the decision is yours . You and you alone are the one that will have to live with the decision to go with lumpectomy or masectomy.  I have called the doctor back ,changed my mind about partial verse radical, back to reconstruction at the time of initial surgery because I wasn't sure about what I wanted due to the psychological ramifications related to the loss of a breast. I guess even though surgery hasn't taken place, I am scheduled for removal of the right breast and even if I decide up to the minute that I would like to change my mind it will be okay. I am still somewhereinbetween with all of this and I guess I will have to trust that I will make the right decision when the time comes. For now I like the thought of radical because that I am.

edwards750

I went for the lumpectomy too but when a micromet showed up in my SN I freaked out and decided that was it and I was getting mastectomy. After the initial shock wore off and I calmed down I had the oncotype test and saw my oncologist. My score was low and the cancer was non-aggressive so I am getting radiation. I agree dont second guess yourself. Hard to do but I decided I would do my homework and go with the BS and Onc decisions. They both are the best. I think no matter what we are all going to be looking over our shoulder at least initially. With time not so much. I just pray and let God take over now. Good luck..

NSWTD

If it were me, I would choose the least invasive treatment.   You can always opt for more agressive if needed.   My suspision is that you read about women on these boards having more done becasue tehy are having more done.   DOes that make sense?   I know of many women in my circle of friends that have had lumpectomy, and then either chemo and or rads and they are now considered cancer free and they do not check in on these boards.     Yes, it may mean more surgeries later, but so what?   A major recon will require multiple surgeries also if you go all the way with refinement.   IF you are otherwise healthy and your body can handle multiple surgeries/procedures, I say go with less before more. However, having said that......as many on these boards write.....they could not take not knowing when/if cancer may strike again and wanted both breasts removed and pronto......so much a personal choice.  

Sandeeonherown

My cancer was just under 1cm and I am a double D...told my surgeon to take wide margins and if there was a huge difference when everything healed, we could fix it later. She did as i asked (and agreed with the decision so that felt good) and she took 7cmx5cmx2cm...no cancer in the lymph nodes..while radiation scared the crap out of me, I did it ....my breast has been saved and I am hoping that is he end of it. if it isn't, and if there is room, I would still opt for a lumpectomy....just where my head is. those who opt for a total masectomy and get the job done, I admire...but I am not there.

bdavis

I am one of the people sitting in the middle... I had a lumpectomy, am in chemo and am supposed to have radiation this summer... I am not wanting to be here again... I told my onc that if I weren't in chemo I may have a different feeling, but I really can't do this again... it is just such a long road.

AND I don't want radiation as I had a left sided cancer (heart right there) 

AND I have other benign stuff in both breasts (some of which was suggested removal by radiologist (a pappilloma)), so I know my future would be filled with MRIs and biopies... 

AND with now 2 lumpectomies, and 2 biopsies in my left breast alone all in my dense breasts, I feel tests, including MRIs, could be compromised.

AND I have a history of ADH and when they did my first lumpectomy of a fibroid, they did not and don't aim to  get clear margins on ADH... so thats sitting in my left breast just waiting to be a new cancer.

SO... I am totally leaning toward a MX over radiation, thus reducing my future risk from 25% to 2% accrding to my onc, who supports me, but feels that radiation is ample.

Too much to decide.

Snobird

Here's my story for what it's with. 2006 DCIS with < than 1cm IDC. Surgeon recommends MX with radiation. Radiologist pushes for LumpX with Rads. Oncologist says either or. PS says no recon until after 12 months post rads for best results no matter which way I go. I can't imagine being breast less so I opt for lumpx and rads on my left side. Not really happy with the choices. I kept suggesting MX with immediate recon and no rads but no one would support that because I had IDC grade 3. I ended up with 2 surgeries to get clean margins and was left with 1/2 breast ( luckily it was the upper half that was left.) fast forward to 2010. A recurrence as Paget's disease of the nipple. Lucky for me I insisted on a biopsy even though both Onc and surgeon thought I was overeacting. I was right and they were wrong. I wish they had been right but I had to go with my gut on this one. Probably saved my life. Anyhoo, after much research and drs visits I decided 2 strikes warranted a BMX and immediate recon. I had 2 strikes against me and 3 strikes and you out was my mantra. Within 2 weeks of my decision I was in surgery with one great PS. I haven't even gone back yet and if this is all that gets done I would be happy although I am planning on the full course of recon. In hindsight I should of had the MX although I probably would have ended up with a BMX anyway due to the damage that was done to the breast from the rads.

bdavis

AND the whole rads thing is a big part of my thinking toward MX... If I get rads, aesthetically it isn't flawless... and a MX plus recon could be better aesthetically... and if I did get a recurrance after rads and needed recon, it would make it more difficult... but most importantly, mx over lump reduces my future risk and lets me almost forget and not worry at all... or only worry 2% over 25%... and I know me... I would worry.

I don't think of MX and recon as the easy way out for sure... I look at it as perhaps the best choice for me, and this year is shot anyway... I know it will be a tough recovery, and will impact my life this year more than rads would, but I am 48 years old and will have the rest of my life to enjoy... And not going into this half cocked... I am seeing my BS in April to discuss MX, even though I will most likely go to NOLA for microsurgery.

kadeeb

My story seems to be a little different from many and it is because of the size of my tumor. 5 cm and it actually turned out to be about 8. Tripple positive. I had chemo first and responded so well that by the 3rd chemo I could no longer feel the lump and neither could my onc (they placed markers or wouldn't have been able to locate it during the lumpectomy). Started herceptin after Adromician. Lumpectomy after chemo and 35 rads after that and now on Arimidex. No node involvement and doing great 4 years later. Had breast reduction in the good boob and put the left overs in the hole in bad one and lifted the girls back on my chest instead of my tummy and I couldn't have done better. Don't let stories sway your decision. Do what's right for you.

Cat123

Gett a second opinion!  I had to make the decision as well and it is a tough one.  My tumour was originally 3.5 and the second surgeon I saw said I would not be happy with the cosmetic outcome.  Decides on left mx.  So glad I did as there was DCIS and Paget's.  The reconstructive surgeons do amazing work now.  I am happy I went with the mx but it is a very personal decision.

JanetinVirginia

is there any ONE thing you could tell me that would tilt the scale as to which type of surgery has the best chance of defeating the cancer?

For me, several things tilted the scale to mastec.   Survival is the same whether lump/rads or mastec; but recurrence rate is higher with lump/rads.  What that means is that if you choose lump/rads and you do have recurrence, once detected it can be treated again successfully (with mastectomy).  However, screenings did not pick up my first cancer and no guarantee the would find a recurrence in time.  I had an excisional biopsy (which is same as lumpec) and margins were not clear.  If I had to have a 2nd surgery anyway, then I wanted to be sure w/mastec.  (Good thing as they found other focal areas as small as 1mm in the mastec. pathology and a 2nd lumpec would likely not have been clear either.)  I wanted to avoid radiation because carries its own set of risks particularly since it was on my left side. So a combination of factors shaped my decision.  The left mastec was Sept. and I wanted to wait to be sure I wanted a bi-lateral.   I'm now scheduled for a right prophy in couple of weeks.  That's my story & no regrets for me.  There is no right or wrong answer.  Once you have considered all the angles pertinent to YOU and how you feel, you will be comfortable w/your decision.  My best to you!

bdavis

Janet... that is exactly how I feel...

somewhereinbetween

Well since my last post I must say that I went with the latter and it didn't turn out bad after all. I mean I still have one good breast to the left and hopefully I have saved my own life with the choice that I decided on. I am thinking on the line of reconstruction but first thing is first and that is I must heal from the initial surgery. You see I had a lot to loose, my breast cup is 46H as if i really needed all that tissue. I am just grateful for the advanced technology that exist that's made it possible for women like us to have a choice about what we feel is best for us anyway, even though I am often stuck somewhereinbetween my decisions. I feel pretty good and I'm very optomistic about future outcomes. I may be somewhereinbetween, however I'm gaining some middle ground