Planning for a lumpectomy but may need a MX

chickensandgoats

Hi everyone,

I am going through neoadjuvant chemo to shrink my 3 cm tumor. I have completed three rounds of A/C and will follow up with Taxol. So far, the oncologist. I've not had any further imaging so far but the tumor appears to be shrinking as measured by touch. The plan is to finish the chemo and then have a lumpectomy and radiation. If for some reason the tumor doesn't shrink enough or something else pops up I will have a mastectomy. I am okay with either surgery as long as I know my team is doing everything we can to fight the cancer.

.My question is will it be obvious what surgery is needed ahead of time? I guess my worry is I'll go to the hospital for the lumpectomy and the surgeon will find something that requires the other surgery. If this is the case do they inform the patient ahead of time or usually go ahead and do whatever they need to do? Do they attempt the lumpectomy and then schedule a follow-up mastectomy to finish the job?

These are questions I need to discus with my surgeon, but I won't see him again until February when we look at scheduling the surgery. I am probably overthinking things, but I just like hearing other patients' experiences. Like I said, I am okay with a mastectomy, would like time to be prepared. I just have this fear of waking up to a missing breast when I wasn't expecting that to happen.

I am probably rambling. I hope this makes a little sense!

Thanks!

Molly50

I had a lumpectomy initially but ended up needing a mx after they found extensive LVI and couldn't get clean margins. Good thing too because I had DCIS in the nipple stem as well. If your surgeon wants you to sign a release to switch to mx if necessary I would find another surgeon. You need time to consult with a PS and to wrap your head around losing your breast. You also need time to consider if you want umx or bmx. I don't think many surgeons anymore do this. That was back in the dark ages where women didn't know if they had cancer until they woke up with no breast.

MTwoman

I had DCIS, and originally chose lumpectomy. After a follow up MRI found more (multi-focal) DCIS in other quadrants, I had to go back and get MX to get the rest of it. You will give them permission to perform a procedure (whichever one you decide, in agreement with your surgeon). They will perform that surgery only (removing the tissue that they determine needs to come out to get good margins). If they determine, after pathology, that they didn't achieve the margins they need for good prognosis, then they will discuss options with you and again, you have to give them permission for the procedure that you chose. You are a very important part of your treatment team! I won't work with any provider who doesn't acknowledge and treat me that way. Their expertise and guidance, but your body, your choice.

mustlovepoodles

Yes, you will know ahead of time which surgery you're getting. The bad old days of ladies going to sleep for a biopsy and waking up with a breast whacked off are over. You will have time to discuss all this with your oncologist and a breast surgeon. If your tumor is large or is going to distort your breast, you will want to talk with a plastic surgeon, as well. They can work together with the breast surgeon to make sure you get the best outcome.

Don't feel that you have to rush into any of this. You have time to work all this out. Chemo is working on your cancer for now.

Italychick

My surgeon did an MRI before surgery to look for any other areas of concern. So may be worth discussing?

chickensandgoats

Thank you, everyone. Your explanations are exactly what I needed. I believe my surgeon is very kind and patient-focused so I will be sure to have this discussion at my next appointment with him. I thought that if needed there would be separate procedures and it sounds like that is the norm. I will make sure to read the paperwork and make sure I know what I am agreeing to before the surgery. Thanks again!

Luna52

MTwoman says it well. The surgeon should go in for the lumpectomy and send the tissue for pathology report.

Having had a lumpectomy, second excision to try for better margins and ultimately a mastectomy..I can tell you that the lumpectomy is very minor compared to UMX or BMX.

It's all about the margins and your surgeon can't determine that.. mine was shocked that both the lumpectomy and second excision pathology resulted in DCIS too close to the margins.

Best of luck, Luna

chickensandgoats

Thank you for explaining about the margins. I guess that is the great unknown until the surgeon is able to see the final pathology report. Very useful information!

ElaineTherese

Hi!

I also did neoadjuvant AC + T. Before I began chemo, my oncologist did an MRI and PET scan. After I finished chemo, I also had an MRI and PET scan. This second set of scans showed that all of the active cancer was gone in my breast and compromised node. Hence, I felt comfortable getting a lumpectomy rather than a mastectomy. Hopefully, your oncologist should order some kind of scan before you plan your surgery. Best wishes!

chickensandgoats

Thank you, ElaineTherese! It is great to hear from someone who has walked a similar path! All of the posts have built up my confidence!