surgical biopsy after DCIS diagnosed with core needle biopsy?

jabec

surgical biopsy after DCIS diagnosed with core needle biopsy?

jabec

I had a core needle biopsy in December and the doctor told met that they found "pre-cancer" cells (never mentioned DCIS) and that he needed to do a surgical biopsy. I did some reading and realized it was DCIS and then let him do a surgical biopsy. I had no idea how big an incision it was going to be or how flat the bottom of my breast would become. When that pathology report came back again saying DCIS (I forced the dr. to admit that that's what it was) the surgeon said the margins weren't big enough so he would have to go back in to get more tissue and then I would do radiation. I asked about mastectomy and he admitted it was an option, but he didn't do them anymore. I then found another surgeon and decided I want double mastectomy. I was told that the mastectomy would have to include the incision from the "biopsy", which essentially was a lumpectomy. However, that incision is at the bottom of my breast which means that a lot of extra skin will have to be removed during the mastectomy and the plastic surgeon I met with said because of this, my TE's will be pretty much flat after surgery. I feel like I should never have agreed to the surgical biopsy. What was the point of it if we already knew there was DCIS? If the surgeon had given me the option of the surgery or mastectomy, I would have told him that I wanted a mastectomy. My new surgeon said that whenever she does an incision, she treats it as if the patient may end up wanting a mastectomy so she tries to get it as close as possible to the areola. I'm upset that the first surgeon downplayed everything and I feel that I should have been given the choices of the surgical biopsy (lumpectomy) or mastectomy after the DCIS was found in the needle biopsy. Can anyone think of a reason why the surgeon didn't talk to me about those choices before the surgery?

MelissaDallas

I think it is more likely the precancerous cells found on the core biopsy were another kind of precancerous or atypical cells-ALH, ADH or LCIS. You should get a copy of all your records and especially your pathology report from the core biopsy. I've never heard of doing a surgical biopsy instead of a lumpectomy or mastectomy when the initial finding was DCIS. They would have wanted to obtain clear margins & that is not a goal with a surgical biopsy.

Also, I haven't heard that about the low scar. My surgical biopsy was done at an NCI Cancer Center & my incision/scar is under my outer breast in the fold, so they wouldn't do that if it would cause a problem if I had needed a mastectomy.

I think you are getting confusied communication somewhere

Ariom

Hello Jabec, Welcome to BCO!

I agree with MelissaDallas, I think there may have been another pre cancerous finding in the initial biopsy too. If it had been DCIS from the beginning, getting clean margins, is always the first line of treatment.

It is a very good idea to get copies of everything for your own records too. If you don't feel confident with the information you have received so far, is going back to the surgeon for another consultation and option? Did you have anyone with you at either of the other consults? It can be very confusing if you are alone in a consult and you are trying to process everything as it is being said.

I wish you all the best, let us know how you are getting on.

LAstar

You can ask for the surgeon's notes also. They might provide some justification of his process. I was surprised at the detail in my surgeon's notes, including an early assessment that he thought I would require mastectomy well before he recommended it.

jabec

I do have all of my biopsy reports and it says DCIS as the diagnosis from the needle biopsy. I am using a different surgeon for the mastectomy and I can't change what was done, but I'm pissed that the second "biopsy" should probably not have been done. When I saw the surgeon in pre-op, I asked him what the purpose of the surgical biopsy was and he told me that he wanted to make sure what they found in the needle biopsy was "not the tip of the iceberg". I understand wanting to know exactly what else might be there, but if I decided i was going to do a mastectomy anyway, what was the point? I went through a surgery, pain and now a scar that will make my reconstruction harder. My scar is at the bottom of my breast because that's where the DCIS was, but I get the sense that the doctor never took into account a possible mastectomy and whether he could "cheat" the incision up a little more.

MelissaDallas

I'd be mad too. I don't think the second biopsy should have been done either & don't believe that was standard of care. That and the fact that the doc "no longer does mastectomies"... Very odd