Has anyone had a 2nd re-excision of lumpectomy? Need advice.

MamaMia41

Has anyone had a 2nd re-excision of lumpectomy? Need advice.

MamaMia41

So, I met with my surgeon about 10 days ago to go over the results of my re-excision.  She told me that the one margin she went in to clear was clear; however, the margin was very close, 0.5mm.  She doesn't usually accept less then 2mm, but this area was down low at the bottom of my breast (literally going down towards the ground if I am standing) and there wasn't much breast tissue left after the re-excision, it is down to the fatty tissue in that area.  There was only one small focus of cancer cells, so she thinks she probably got it all out and these were just some stray cells.  I thought she was going to recommend a mastectomy, but she didn't; she said that because this margin was headed down and not centrally located in my breast  and heading toward the nipple it was not necessary and I should make an appointment to see radiation onc.

My appointment with the radiologist was yesterday, it didn't go well.  He basically said that he is not comfortable starting radiation because my margin is too close (despite where it is) and because of my age, I am 42.  He said that typically they are more aggressive with surgery when a patient is younger.  I called my surgeon when I got home and she had already spoken to the radiologist.  She said that she thought I should have another re-excision to obtain the margins required by radiology.  She is adamant about the fact that I don't need a mastectomy because this is just in the lower part of my breast and the rest of it is fine. But, since she will be removing mostly fatty tissue (and there was already a good amount of tissue removed in previous surgeries), I will probably need partial reconstruction to correct the deformity that will be left after surgery and radiation. I am willing to have the mastectomy if that is what's best and I told her that; she doesn't want me to make any hasty decisions because I am tired of dealing with all this. 

My question is, what if there are more cancer cells in this 2nd re-excision?  Do they ever do 3rd re-excisions?  I am told that my case is pretty unusual; I don't want to make the wrong decision and I am thinking about getting a second opinion. Does anyone have any experience/advice on this matter?

sushanna1

You are not alone.  I had an excisional biopsy, followed by a lumpectomy and a re-excision because of a a close margin.  I had expected to to have to have a mastectomy, but the re-excision was successful.  It is doubtful that you will be offered a third re-excision.  I think that it is somewhat unusual to be offered a second re-excision.  My surgeon also took a different point of view from the radiologist.  Try to remember that both of them are just trying to look after your best interests. 

Good luck.  These are not easy decisions.  My small (A) breast looked OK after the first three surgeries.  It took another two excisional biopsies to really affect the appearance.  Each time I was faced with another biopsy, I would wonder whether or not I should have opted for a mastectomy, but that is the only time that I questioned my decision.  

sweatyspice

You might try PMing Kitchenwitch, she's had several re-excisions.

Emaline

My doctor wanted to do as yours, re-excision. He was sure he could get clear margins but it went up for review to the tumor board and they said no go.  My doctor did say if it was what I wanted to do, then he could do it.  However I have opted to just have a mastectomy.  It is the right choice for me.  I know from reading around on the board, re-excisions are common and often times they do get clear margins.

Snobird

I also had a re excision for clear margins in the same area as you. 2 years later I had a recurrence and I am now 4.5 months post BMX( bilateral mastectomy) with DIEP (reconstruction). I also had radiation therapy after the the LX( lumpectomy). For my two cents if you can have the MX with immediate recon and avoid the RADS. That is what I would do. If you can't avoid radiation then I would either do the LX and have total recon done later( probably 6 months or so) or have the MX, RADS and then the recon. Don't have TE and implants before radiation if you can help it. Check out the Breast Recon site for more input if that is what you are considering. Get more than one opinion if you need to.

ruthbru

Had a re-excision because the margins were too close. It went fine and I have been fine since.

MamaMia41

Thanks for your comments, it's nice to know I am not alone.  I feel like I am losing confidence in the lumpectomy procedure; but I know my BS is right in telling me not to make a quick decision for MX because I am upset with the process (don't hate the player, hate the game-right?!).

I am going to schedule a consult with the plastic surgeon like she suggested and ask about partial recon and recon after MX.  I have been researching them both so much, I feel like I know what he will tell me.  There is a such thing as too much information, and I think I'm there.

I appreciate you ladies!

Snobird

Mama if you are going to have recon at all I would not recommend partial recon. With partial recon you are left with breast tissue in the breast which could become a new or recurrent cancer later. For all the effort put into recon don't waste it on partial. I had a skin sparing recon which keeps my original skin and stuffed belly fat in the breast and I will have new nipples constructed. They look normal and feel normal to the touch albite numb inside right now. You will also have more scaring from surgery with a partial. You should check out sites such as NOLA or Dieflap.com for photos.

MamaMia41

Snobird, thank you.  I didn't even think of all that, you bring up some good points and I will discuss them with the plastic surgeon.

Can you tell me about the surgery and recovery? 

Snobird

The surgery, in my mind, was not as difficult as I had built up in my own mind. I knew that it was the right choice for me and I was willing to take the small chance that it might not work. My PS is well regarded and only does flap surgeries. He questioned me extensively prior to surgery and indicated that I was a great candidate for the DIEP Flap which was what I wanted. He also explained to me that if I wasn't a good candidate he would not do the surgery but recommend an alternative procedure and/or PS to me. I felt that I was in good health other than the BC and I had no problems with healing or anesthesia with prior surgeries so being under for 6 to 10 hrs was doable to me. I would not have done this procedure with just any PS. I wanted someone with extensive flap surgery experience and I was willing to travel for that.

The surgery went well. 7.5 hrs with BS doing a skin sparing BMX and 2 microsurgeons performing the DiEP. That 's a lot of open area of my body and I'm glad I was out for all of that. Recovery was really tough for the first 24 hrs that I was awake. Major painkillers. Nurses in and out every hr. Checking the flaps. After about 48 hrs things got much better and I was up and walking around. I had a little problem with back spasms that the PS gave me Valium for and that really helped. I was out of the hospital after 4 nights. The drains were the biggest pain and I was happy that they came out after 10 days. I didn't have to wear any compression garments or special bras after surgery. I wore soft stretchy camisoles for about 5 weeks post op and then I wore jog bras for another 5 weeks. At 4 weeks my husband and I drove 3 days to CO for a ski vacation for a month. I started skiing 1/2 days at 5 weeks and was skiing full days at 6 weeks out. I have lost 15 lbs since the surgery and have a very flat tummy from the surgery so I have dropped 2 sizes in pants. I feel physically real great and much better mentally than I did looking at my deformed pre surgery breast. Still have issues dealing with BC in general but surgery was way more beneficial for me and my state of mind then even I would have predicted. I have not had Stage 2 yet so I can't comment on that yet.

BreakingBad

I had oncoplastic surgery, which is basically a lumpectomy plus a reduction and lift on both breasts. This is an option for large breasted women and the benefit is it allows the surgeon to take twice as much breast tissue than usual. My surgeon was totally astonished not to achieve clean margins after that procedure. He somewhat reluctantly suggested a re-excision to try for clean margins. I initially agreed to this and we set a date, but after thoughtful consideration called him back and told him I wanted the mastectomy. I too had a Grade 3 tumor and didn't want to take the chance. I had a unilateral mastectomy with immediate Diep. I am five weeks post op, feel great both physically and mentally especially about my decision. My new Diep breast looks beautiful and if I am being honest, so much better than my original breast.

TinaT

MamaMia41:  Someone mentioned skin sparing mastectomy.  Since your lesion sounds distant from the nipple you might ask about nipple-sparing mastectomy.  I had both lobular and DCIS in the same breast so had to choose between single and double mastectomy.  I am dealing with some healing issues (reaction to the blue dye used for the sentinel node localization) so that side is still struggling.  Honestly, though, my other breast looks amazing and it's only at the partially filled tissue expander phase (I'll have silicone implants down the road).  My breast surgeon did the incision below the breast.  One major downside of nipple-sparing surgery is even though you keep you own nipple/areola it is pretty unusual to have any sensation there.  So, looks good but doesn't feel the same.

I know it's overwhelming.  But, there are lots of options out there.  Best wishes!

MamaMia41

Hi everyone,

Thanks so much for the great advice.  I have been thinking a lot about all the good information you have posted and it has really helped.  I have been looking into the skin sparing and nipple sparing MX and I will ask PS and BS about them both.  The partial reconstruction doesn't seem too appealing after what I have read from you ladies. Thank you Snobird for all the details on your surgery, skiing at 5 weeks out-amazing!

Going to call PS tomorrow to set up consult, will keep you posted.