Positive margins after DCIS MX - surgical options?

harrietv

Hi ladies - I'm in the UK and find this site invaluable. I've been through all the prior threads on this topic and they've been so helpful, especially to see what treatment options you can get in the US vs UK. 

Recovering well for BMX for DCIS in right breast. I'm 38 years old. My final pathology showed 7cm of high grade, comedo necrosis DCIS (3.5cm in first lumpectomy, additional 3.5cm in mx). No microinvasions, no invasivity. All good apart from my anterior margin which is less than 1mm over original surgical site. I also believe my chest margin was only 1mm from original pathology but at it was at least 1mm. 

Having researched all your posts I think what I want to do is a surgial removal of the skin overlying my original, palpable lump which was removed in first lumpectomy, to clear the margin.  However I had immediate recon with silicone implants and am wondering if this is possible? Is there enough stretch on the skin to allow them to remove some skin? Or will my recon fail? Perhaps I can wait a few months till I'm a little more stretched round there? Although I have a large area of DCIS I think it's long and thin and only at most 3.5cm of length is +ve.

I already know the opinion from team is 'no further treatment' and straight to 1 yearly physical exam. So if I want further treatment I will need to fight for it. Want to make sure I fight for right thing.....

Would rather have surgical resolution than radiation due to SEs of rads, likely capsular contraction, having it in backup if I ever get an invasive return. Maybe that's a mistake? BTW It is not standard practice to treat postivie mx margins for DCIS with radio here in the UK. 

Any advice/help much appreciated. I seem to have a 12/12 score on the Van Nuys PI which makes me nervous. Even removing my margins would only take me to a 10. Perhaps I have to accept a higher level of risk. I'll find that hard.

LAstar

I had the same situation after my BMX. My breast surgeon insisted that MX margins are very different from lumpectomy margins, and felt that I had nothing to worry about with an anterior margin <1 mm.  He decided that a patch of skin around that area would be removed at my second stage flap reconstruction surgery. He said that he'd seen some imaging of DCIS in microscopic ducts that had extended into the skin layer, and he was concerned that this scenario contributed to recurrences. My final pathology indicated that no DCIS was found at all, so I was very relieved. Maybe you could have a similar procedure at your exchange surgery for peace of mind?

harrietv

Thanks LAstar - that's really interesting. 

I saw my BS on Friday and turns out he already removed some of the skin that overlaid the original cancer area, as part of my MX and that was what had the <1mm margin on the pathology report - since the skin is gone, so has the DCIS.  Of course I still worry that there's other bits of skin behind that bit of skin which still are not free of DCIS but I guess at this stage I have to trust my surgeon who says he's completely confident everything's been removed. It's weird to suddenly be at the end of treatment and to believe it's all really gone. I guess as time goes on it gets easier?!

LAstar

You have a great BS!  I still worry sometimes, but I remind myself to trust this process and not read the recurrence stories too often.  Best wishes!