Close but Clear margins after lumpectomy. Dense tissue.

vivorme

Thank you for this forum. I read numerous articles after my diagnosis a few months ago and found them very helpful. I'll post my BC experience and hopefully it will help someone else.

Diagnosis: DCIS, grade 3. Original tx choice was lumpectomy with rads and tamoxifen. However, that changed.

First lumpectomy removed an area of DCIS, grade 3, of approx. 3cm. I was told all margins were good, except one. It was close, but clear. That margin was 0.2mm. The BS wasn't happy with that and encouraged me to do a re-excision lumpectomy to increase the margins. She told me DCIS can "jump" around the milk ducts, so one milk duct can have areas of disease and areas of health. For this reason, the BS wanted margins of 2.0mm. I was told it was my decision. We did an 2nd lumpectomy. Those margins also came back "close, but clear". Instead of the anticipated healthy tissue being removed in the re-excision, additional DCIS was found. So this time, the margins were 0.4mm. My BS did not want to do another lumpectomy, because my breast was already showing signs of a clear indentation from both of these surgeries. Her recommendation was to continue as planned, with radiology and tamoxifen. I was told it was my decision, but wouldn't want to see me jump to a mastectomy based on this additional small area of DCIS.

My choice was double masectomy because I was not comfortable with margins of 0.4mm, when the ideal margin is 2.0mm.

My post mastectomy pathology report showed an additional, previously unknown, area of DCIS of approx 3.0cm, grade 3. I'm still shocked that they didn't know it was there. I have always been told that I have extremely dense breast tissue. I've had annual mammograms for 10+ years, and 3 core biopsies. I can only assume this area of DCIS was hiding from their view by being masked in the dense breast tissue. If I had done the radiation tx, it would not have addressed this new area. Perhaps the tamoxifen would have stopped any further progression? For me, with my history of previous biopsies, and being told my breast tissue was 'active' and dense, the mx was the right choice.

dtad

Just curious if you had a breast MRI pre op? If not this again another example of how important it is ,especially with dense breasts. Good luck and keep us posted..

vivorme

Yes, I did have a breast MRI done. They only saw the area they expected to see, where the biopsy had been done. They did not see the new area.