And sometimes the choice is made for us...

jadeblue

Hello all. In another thread, many of you helpfully shared your experience of how you arrived at your choice of mastectomy vs. lumpectomy for DCIS and how you felt about it afterward. I really appreciate all of your stories and am grateful to you for taking the time to share.

I finally made peace with lumpectomy (my DCIS, although high-grade ER-/PR- with comedo-necrosis and micro-invasion seemed to be very well concentrated in one relatively small area). All tests (mammogram, MRI and ultrasound) revealed no further "areas of concern," so I went ahead with the lumpectomy and it went great. The surgeon was very confident that she got it all with very good margins. Truly, she did a beautiful job.

Yesterday the pathology came in and, while some of the news was good (unmeasurably small microinvasion with no lymph node involvment), there was something very peculiar about my margins: there was a very wide clear space (1 cm. or more) on all sides of the cancer, and then, in two directions, more high-grade DCIS! This second 'surprise' area did not show up in mammograms, ultrasound, or MRI. I'm fortunate that the surgeon happened to graze it when removing the known area. Because it's undectable, they don't know how big it is and can't map what area they'd need to excise (assuming I even had enough tissue left to excise, which I really don't).

So, all this 'lumpectomy or mastectomy?' debate and there's really no choice after all: I'm having MX. Actually, I'm having BMX, both for cosmetic reasons (I'm small-chested and would be quite lopsided after reconstruction) and because I am prone to DCIS that's high-grade, ER-/PR-, microinvasive and now POTENTIALLY UNDECTABLE BY ALL AVAILABLE MEANS. Uh, no thanks.

At least I'm grateful that the circumstances played out with so little ambiguity. It allows me to feel really peaceful and confident about my decision. And when I feel sad about losing both my breasts at age 44, I cheer myself up with the knowledge that I get to skip radiation. That (and no more mammograms, breast biopsies, etc.) is a very nice consolation prize to an otherwise not-so-lucky turn of events.

Best to everyone. And thanks again for all your kind words and helpful comments.

-Jade (probably close to 14.5 acres of high-grade DCIS with mystery microinvasion; ER-/PR- with indeterminate HER2 status; 0/2 + nodes )

rc778

Jade,

I also experienced a strange sort of peace when I made my decision to do a BMX at 41.  I never second guessed myself.  I know that no option is 100% in the world of BC but I know that I made the right decision for me.  If it helps, I found the BMX to be much easier than I expected.  Good luck to you!

vmudrow

Jade - I too felt peace when I finally decided to have BMX.  Ask your doctor if you are a canidate for nipple/skin sparing masectomies.  The surgery really isn't that bad and YEAH for no more mammograms and multiple biopsies!!

Snobird

I wished I had done the BMX/DIEP the first time around. It's done now and I'm can hopefully move on from here. I actually think that a MX or BMX is a better option if it helps to avaoid radiation and chemo.

azul115817

Hi Jade,

As I mentioned on another thread, I first had a lumpectomy and then ended up having a bmx after pathology showed narrow margins in 2 areas.  I could have had a reexcision, but like you, the extent of my DCIS was not detectable on mammogram, ultrasound or MRI.  At that point, I decided to have a bmx.  Not being able to see or detect the DCIS was very unnerving, and I just wanted the breast gone at that point.

The pathology after my bmx showed residual DCIS.  Maybe a reexcision or radiation would have taken care of the remaining DCIS, but no one knows for sure.  Knowing there was still DCIS left in my breast after the lumpectomy (with clear but narrow margins) confirmed to me that I had made the right decision.

I did not find the bmx or reconstruction process to be bad, and my cosmetic results are very good.  Like you, I am happy to avoid radiation and future mammograms.

Best of luck with your bmx!

Heidi

Lovegolf

Yeah when the path report after my BMX came back it showed DCIS that was not seen with mammo or MRI...scarey. 

rianne2580

Jadeblue,

Surprises are an understatement in this business of cancer. I originally had DCIS and toiled over lumpectomy. Then MRI lit up where IDC was hiding in a different quadrant of breast. That rules out lumpectomy and I had a RMX on March 29. IDC was 4 mm highly differential (slow growing) grade 1. I thought SNB NO BIG DEAL, that tumor is so small. Cancer is not for the faint at heart. A micromestesis, less than 2 mm in my SN. So that puts me in a different category. I have not met with the oncologist yet, but according to the NCCN for treatment of BC, I should not have chemo and there is no reason for radiation or so I thought. My margin near the DCIS is 1.9 mm. I think that's good enough, but nothing will tell me in all the sites I've been to. I honestly do not want any chemical treatment, and I know I can say "no." I would do much worse with chemicals than with surgery, I know my body. If anyone knows about that margin issue, please post.

Many blessings to you Jadeblue!

azul115817

Rianne,

I'm not sure about your situation, but when I had a lumpectomy for DCIS, my pathology came back that I had 6mm margins on most sides but 2 areas with 2mm margins.  My surgeon said at that point that we needed to either do a reexision or a mastectomy to get wide enough margins.  Under that hospital's protocol, 2 mm was not sufficient.

As it turns out, the pathology from my mastectomy showed residual DCIS, so I'm glad my BS didn't accept the 2mm margins as adequate.

Good luck with your future treatments!

Heidi