Too Beejay123

OldOakTree

Sorry if this is a duplicate, it didn't seem to go through the first time I hit submit.

 (Copied from Beejay123's post) 

Hi everyone. New to this board. Have spent the past few nights reading posts on several topics. Still more confused than ever.

Received DCIS diagnosis on 7/5/2011. Consulted with surgeon on 7/13/2011. He recommended what he called partial mastectomy with incisions down middle and under breast to "get best possible result." I am  small breasted so even with care will still look like a chunk of breast tissue is missing. Will need reconstruction to return nipple to original position. If radiation called for will shrink breast further, maybe a cup size difference according to surgeon. But, honestly, even though I opened with this, I'm less concerned with the cosmetics than I am that surgery is necessary at all.

After visiting this forum, I called for a copy of the pathology report and received it yesterday. Thank you all for reminding that I should have that. Here's what it said:

FINAL DIAGNOSIS: Stereotatic core needle biopsy, right breast. Ductal carcinoma in situ. Nuclear grade: Intermediate. Patterns: Cribriform, comedo. Necrosis: Comedo-like. Intratumoral microcalcifications: Present. ASSAY RESULTS: ER+/PR+. COMMENT: Four ductal units are involved in the ductal carcinoma in situ. That was it! Couldn't find any reference to size other than in earlier report to my doctor recommending a biopsy: "Calcifications demonstrate slight variation in size, shape and density. They span a distance of approximately 4 mm. Millimeters!!!! What's more, had an MRI before the surgeon consult and he told me that the microcalcs had been removed in the biopsy!

Although I'm concerned, very concerned, why do I feel that they're trying to use a shotgun to kill a gnat? Why do I need surgery at all? Is "wait and see" a good strategy in my case? Or am I just hiding my head in the sand avoiding the inevitable?

Feeling crazy right now. Thanks so much for any and all insights. Oh, btw, I am 63 years old with no family history of breast cancer

Beejay I am very sorry your post got hijacked and you received so many responses that had nothing to do with what you were asking.  This does happen every now and then but it isn't the norm.  If I may, let me reiterate what others have said.  The core biopsy takes only samples, it cannot possibly tell you anything about margins or give you an accurate estimate of the full extent of DCIS.  You may or may not have more in there, the only way to tell for sure is a lumpectomy.  "Millimeters" doesn't mean a whole lot on a core biopsy, that is all they remove, they don't remove centimeters.  The purpose of the stereo biopsy is to see if more action is warrnated.  The fact that they did see comedo necrosis is reason enough to have a lumpectomy, that in itself is a red flag for a more agressive cancer.  The calicifications are not the cancer, they are only markers that the cancer is there so there could be something beyond the cals or hopefully, there is nothing else.

Wait and see approach - probably not a good idea - wouldn't you rather have it removed now than wait and see what it may become in 5 years.  I don't see it like shooting a gnat with a shotgun, I see it more like emptying the standing water in the back yard so you don't get infested with malaria spreading mosquitos.

I have small breasts (A cup) and had a good sized chunk taken out of me, yet it is barely noticable.  As others have suggested get a second opinion.  Perhaps another surgeon can recommend surgery in such a way that you wouldn't need more reconstruction.  Your age is on your side as is the fact that you don't have a family history of bc.   If nothing else is found in the lumpectomy (yes, that's the same as a partial mastectomy) there may be no further need for radiation.

Please post back to let us know how your are doing.

eileenr56

Well, a couple things.  You do have time.  DCIS is not an emergency.  You may want to talk to a plastic surgeon before having anything done. 

I had a lumpectomy a year ago.  I have a relative that had a partial mastectomy 24 years ago.  They took the bottom half of her breast.  she told me the bottom was like a shelf - round on top and then a shelf.  The within 6 weeks her breast was round like the other one.  everything distributed on its own.  she never needed reconstruction.  she is also small breasted.  I don't know if she is unusual (very lucky).  It probably depends on alot of factors.  Hers with the bottom of her breast so i guess gravity helped.  Mine was the tip.  It is flat, like my tip is missing.   I have a seroma (scar tissue) behind my nipple (which is getting smaller over time).

If I were to do this again, I would talk to a plastic surgeon before having anything done.  The surgery didn't hurt at all.  I had a recision and that did not hurt at all.  They gave me pain killers and I took one, just in case, but never really needed it.

Radiation does not hurt at all.  Follow what they tell you. 

I feel incredibly fortunate.

Good Luck

3monstmama

Hey Beejay 123!  welcome to the club you didn't want to join.  many many <<hugs>>.  I didn't read your initial post but have heard of it and thought I would give you my 2 cents.

When I was diagnoised, I met with a surgeon who was going to do something similiar to what you describe.  I am small boobed so what was proposed sounds like half a boobie.    And it would require plastic surgery after radiation to fix it.  Like you, I felt overwhelmed.   I was also extremely frustrated by the idea that I wouldn't get to see a PS or oncologist until after my surgery.  That seemed so ass backwards to me.  

Then I learned the neat part about DCIS---you don't have to decide everything in the first week!  So I set-up more appointments.  I met with a brilliant PS with the personality of House on TV (who told me if I was seeing him after a lumpectomy, something had gone "very very wrong."), a not so thrilling PS (with dirty fingernails from gardening--DH said no way was she cutting into his wife!), a wonderful oncologist, a radiation oncologist and another surgeon who was actually part of the same practice as surgeon #1.  Surgeon #2 made me feel comfortable--she answered all my questions and I felt comfortable.  I knew I wanted her to do the surgery.  When I spoke to the nurse and tried to say something about not wanting to hurt Surgeon #1's feelings, the nurse stopped me and said "it doesn't matter.  You need to pick the one who is right for you.  No reason is necessary."

My diagnois was in November '09, my surgery was in February '10.  Even with grade 3 DCIS with necrosis ---which my oncologist described as not a question of would my DCIS become invasive but when would it become invasive--I did not put my life at risk by waiting.  I did get to find medical personal that I felt comfortable with.

Post-surgery, my oncologist and the radiation oncologist both said zaps were necessary because of my grade of DCIS.  It wasn't so bad--the team was EXTREMELY professional and kind and the terrible tattoos so small I can barely find them.

I would disagree that a lumpectomy is the same as a partial mastectomy.  A year out, after a lumpectomy and a reexcission, you can't even see where the surgery was.  The "girls" look about the same, well except badboobie has a nipple pointing slightly left but no big deal and only noticeable to me.  Surgeon #2 said that you can rearrange boobie contents so to fill in places and that seems to be what she did.  I don't even have a divot which I know many women do end up with.

A lumpectomy that amounted to a partial mastectomy--what was being proposed by surgeon#1--would have necessitated plastic surgery.  This is where the excellent PS--lets just call him "House"--came in telling me if I was seeing him after a "lumpectomy" something had gone very very wrong.  Indeed, he said that if they needed to take that much out, I would get better results by just having a mastectomy which would enable me to skip radiation.  Radiation is hard on your skin and can impact healing with subsequent surgeries.

Hang in there!!!!  If you have questions, feel free to PM me!

CTMOM1234

This is a copy and paste from my post last night on the original thread in case op isn't reading that one anymore:I want to take the opportunity to thank the moderator(s) for deleting posts that were truly wrong and hurtful (and I have a thick skin).I hope the original poster gets the information she needs from her doctors, but also does understand that no matter how sure she or anyone else is that "it's just dcis, I can't die of that," you absolutely do not know until the final pathology report from the lumpectomy or mastectomy. A biopsy is just a sampling, it isn't definitive (I know), an mri isn't definitive (I know), nor is a mammogram or ultrasound (I know). When the final pathology report from my lumpectomy to remove some grade 2 (not even 3) dcis came back revealing a trace amount of invasive bc, then I definitive knew. Every day I live with the fear of what could have been and what might still be, but I also thank my lucky stars every day that I didn't watch and wait. I'd previously posted about how my lumpectomy(a.k.a. partial mastectomy) and even rads. weren't bad cosmetically, but this second post is not about the cosmetics. It's about the honest reality that no one should be lulled into a false sense that their dcis diagnosis can be anything more than a guesstimate until they have either a lumpectomy or a mastectomy. That's the awful reality of it. UPDATED AFTER READING PREVIOUS POST TO MINE TO ADD: I had a partial mastectomy, but use the term lumpectomy as a synonym. If there's a difference in these two words, I cannot comment. But I do know that I look the same as before surgery, wear the same bra, and did have a good chunk removed and then I went through rads. No plastic surgery required.