Mastectomy or lumpectomy with radiation?

jillybeantabby

Hi all, I'm posting on behalf of my mother who was recently diagnosed with breast cancer in her left breast. She's blind and can't use the computer, and we don't know anyone who has had breast cancer and had to make these kinds of surgery decisions before, so this forum is helpful. I hope I'm posting in the right place. She has invasive ductal carcinoma, grade 2, and the cancer is estrogen and progesterone positive, HER2 negative. The tumor is 1.7 cm and about 5 inches away from her nipple. She has been given the choice of either a lumpectomy with radiation or a mastectomy, and we are really struggling to decide which one.

I'm worried about lymphedema, which I understand can happen regardless of which surgery you pick, but does anyone know if one surgery/treatment would make that more likely to happen?

My mother has said that she doesn't care about conserving her breast so if she did go with a mastectomy she would not have reconstruction, but she is worried about recovery from the surgery. I think she is leaning towards lumpectomy because it's a smaller surgery, but she really can't decide. We also don't want a recurrence (who does?) and from everything we've heard the survival rate and all that is the same with both procedures. I have read so much about both of these surgeries but we are still completely stuck. I just want what is best for her in the long run, and it's her decision to make, but we would really appreciate any input from some women who have also gone through this and had to make this decision.

Racy

Hi, it sounds like you are well informed about the options. Results of research show that both are equally effective. Radiation obviously has a longer active treatment time/commitment and that may factor into your mum's decision if she is working/unable to get time off or has to travel far for treatment.

I chose lumpectomy, chemo, radiation and antihormonal tablets as I did not want to lose my breast.

It's a personal decision and there are many topics here that discuss the pros and cons of both.

Best wishes to your mum and you at this time.

jillybeantabby

Thank you for your input we really appreciate it. I will keep looking at some topics that go over the pros and cons.

ML1209

i just decided to have a lumpectomy. It is a hard decision. Nurse will be calling today to schedule. For me, I decided if survival rate is the same .... as the mother of 3 children, the least invasive with less recovery time would be the best.

Racy ....would you mind sharing your experience? My BS has offered two options. First is lumpectomy with a mini lift and a possible prosthesis that will dissolve over the next year and allow the gap to fill in. Second is lumpectomy with reduction. I wasn't expecting these two choices so no back and forth on this. The reduction seems pretty involved. Thank you!

Prayers for your mom's decision jillybeantabby.

Racy

My experience was quite typical. I had the initial lumpectomy and SNB and then had to have a second lumpectomy to get clear margins, and also had 22 nodes removed due to isolated tumour cells being identified following the SNB. No further cancer was found in the additional nodes removed. This was in 2010 and a few things have changed since then in terms of treatment options becoming more conservative.

Beesie has written a comprehensive comparison of lumpectomy versus mastectomy decision making. I'll see if I can find it.

LisaAlissa

Hi JillyBeanTabby!

I see that Racy is looking for Beesie's list, but since I just used it last night, I knew right where it was. (lol) (Hope that's ok, Racy!)

You'll find it "here." You'll notice that she doesn't suggest one or the other, just lists lots of the things that you might consider important. Some will resonate with you, others not.

My very best wishes to you as you make your decision!

LisaAlissa

Alli

I have had both types of surgeries. 10 yrs ago at age 36 I had lumpectomy and rads. Ended up with a drain for a week and was out of work 4 weeks after surgery and also during rads. I have had no noticible problems from rads being done on the left side.

During the next 10 yrs I underwent increased monitoring with alternating MRI and mammos. I had 4 b9 biopsies. All in all I tolerated the high surveillance well psychologically. After my first diagnosis both my mom and sister were diagnosed with BC.

I had a recurrence 10 yrs and 1 month after my first dx. I always knew that I would choose BMX if I had BC again. I have no regrets about keeping my breasts for those additional years and I do miss them but have absolutely no regrets about the aggressive surgery this time around.

It is such a personal decision but remember there is no wrong choice. It all boils down to what your comfort level is in regards to frequent monitoring and the possibility of call backs for biopsies. In my case, I was confident that because of increased monitoring, if I had a recurrence that it would be found very early stage which it was.

Best wishes to you all struggling with these decisions. You will not make the "wrong decision". Many folks are way too free with giving advice that have not had to face these decisions. Remember to take their opinions with a grain of salt and go with your gut after your have received all the facts

ML1209

Thank you all for sharing your experiences. It really does help. I am scheduled for my lunpectomy for May 24th. My doctor also will do a minilift. I can't seem to find anyone who had done this, but he seems to do it as part of the lumpectomy for symmetry. Anyone have experience with this?

jillybeantabby

Just wanted to let everyone know that my mom chose to get a lumpectomy. She had the surgery today. Thank you all for posting here and helping us out.

Hopeful82014

jillybeantabby, thanks for the update. I hope your mom's surgery went beautifully and that she gets good news from her pathology report. Take care of yourself as well as looking out for your mom.

MamaOz

hi all, i am scheduled for a bmx sat may 20,2017

I may dtill need radiation, anyone out there had that situation

ReginaZ

ML, my surgeon never said he was going to do a mini lift, but he gave me a great cosmetic result. My tumor was at 6 o'clock and he pulled some of the chest wall skin up to keep the nipple from pointing down, with the breast being lifted as a result. I am probably going back to have him do a lift and reduction on the other side. Would be great to be able to go braless

ML1209

Keep us posted on your mom jillybeantabby. Prayers she is doing well. Thank you ReginaZ - love to hear good results!

jillybeantabby

I will let you know what her pathology comes back as. So far everything has suggested that it hasn't gone through her lymph nodes, but we won't know for sure until the results come back. Hopefully good news and good health is coming for us and for you. I think I read you are getting a lumpectomy soon ML, I hope that goes well. Prayers for you

TEW-61

on May 4, 2017 my life was rocked - breast cancer - no history of cancer in my family !! Im 56, I saw the surgeon on the 16th- Wow - now I'm trying to decide - lump/chemo/radiation or mastectomy/chemo. I'm supposed to be giving my answer this week, but as of today, I still can't make up my mind. First let me give you all some results - invasive ducal carcinoma, stage 1, grade 3, ER+, PR-, HER2+, 2.1cm. I know that statistically the outcome is the same, as far as cancer reoccurrence. At first, I wanted them "both" gone, then lumpectomy,then just the right one. Ikeep going back and forth. Please - I need guidance- my head is spinning. I have such a wonderful support system, but none of them know what I'm really going thru

Anonymous

TEW I am also facing similar choice: mast+hormone or lump+rads+hormone

My healthcare team however is NOT making me choose right now. My breast surgeon (who recommends the lumpectomy) says "We can always take more later, but we can't take less"

She says many women decide on mastectomy AFTER lumpectomy, as the lumpectomy gives more information -- did it travel to lymph nodes, did they get clean margins, etc. There's a chance with mastectomy you might still need rads (though a lower chance) if they can't get good margins near chest wall or something. She also has set me up to speak with rad oncologist before I decide

The main thing is you DO want to decide before radiation, as rads can make future healing/reconstruction harder. But you may NOT need to decide before doing a somewhat exploratory lumpectomy.

Also I'm applying for genetic testing, the BRCA gene test which if I get might help me make my decision.

Don't let them rush you. Make sure you are getting all answers you need to make the best choice for you.

jenco60

Do your research. If I could do it all over again, I would NEVER do Chemo or Radiation. I had a 3.5 CM Lump and after all the horrible chemo it was still 2CM. Had it surgically removed. Had 22 horrible radiation treatments, left incredible scar tissue in my breast and I have pain all the time in my left breast.

Consider surgery only, consider immuno therapy, get at least two opinions and make sure the doctors don't know each other.

This is a financial soaking! I spent 1.5 million dollars for treatment and tests I never needed. I had NO lymph intrusion at all and it was a waste and danger to my health. I am now working with an MD to get my body back to normal. I have horrible blood results and trying to keep my kidneys working normal.

I would NEVER do chemo or radiation again.

Lula73

For what it's worth I did double mastectomy. Had to have ultrasound on my legs for blood clots and in talking with the ultrasound tech she said if it was her she would've done the same and gone with the double mastectomy. Too many women are repeat customers roughly 7 years later with a recurrence in the same or other breast. I know this isn't evidence from a clinical study, but I think we need to start asking more questions about these studies that show no significant difference between the two options- how many years later are we looking at (5 years is not enough as I want to live a long life into my 80s or 90s not just to age 48), what is quality of life like with increased vigilance mammos and MRIs, et

BellasMomToo

TEW: Have you met with an Oncologist yet? Since you are Her2+ and your tumor is greater than 2 cm, your oncologist may want you to do neoadjuvant (before surgery) chemo. That would give you time to decide on your surgery options.

I decided to go with the mastectomy, mainly because I wanted to avoid radiation which would have been required if I chose a lumpectomy. (Fortunately I didn't need radiation -- my tumor wasn't near my chest wall and my SNB was negative.)

Kicks

jenco60 - I am sorry that you had the experiences you had BUT not everyone does have the same. It might help for ones replying if you would fill in your 'Profile' so others could see your DX and TX.

I did neoadjuvant chemo, UMX, adjuvant chemo, 25 rads and have been on Femara/letrozole for 7+ yrs. I'd do it all again in a 'heartbeat'. IF I hadn't - there is no way I would be alive today (IBC). I am a very healthy, active, loving every minute of life woman!

Different types of BC (DCIS/IDC/ILC/IBC) are just that different - there is no 'One Size Fits All'! Just as each of us enter TX differently. Some have other health issues that empact on them and their TX, some enter with few to no other health issues.

NotVeryBrave

I agree with BellasMomToo - for >2 cm tumor and HER2+, chemo first will give you more time to decide.

I opted for BMX because I wanted to avoid radiation and not have to continue to watch "stuff" in the other breast. It's an agonizing decision.

The NAC completely eradicated the cancer. I wish I could have chosen to do NO surgery, but that is not an option. And scans are never completely reliable. I had to wait for the final path report to know that it was really (?) gone.

ruthbru

Having a mastectomy is NOT a guarantee that you won't need radiation, so that should not be your main reason to choose a mastectomy. Everyone has different takes on what to do, and neither is wrong if you go into it with all the facts. I liked having breasts, was pretty sure that I would not be willing to make to commitment to the process of reconstruction (extra surgeries, down time, pain, uncertain results etc.), I knew that the more extensive any surgery is, the more chance there is of things going wrong, and I wanted to get the whole thing done as quickly as possible; so I had a lumpectomy, radiation (and chemo, but that is a separate issue and has nothing to do with the type of surgery you have). I am 100% sure that that was the right decisions for me.

Meow13

actually, radiation was a large reason I did a mastectomy. I had 2 tumors and a suspicious area, my breast surgeon said the tumor board said mastectomy. I did it, with DIEP reconstruction. Everyone has their own case, do what you want to do.

pink_is_my_colour

When I was first diagnosed I was determined that I would get a bi-lateral mastectomy. I figured why keep something that is going to give me problems. I've always had small breast. I thought by the time they took three lumps out of my left breast there wouldn't be anything left and I didn't want to be lopsided.

Once I met with the surgeon she told me that she could easily do a lumpectomy. I also did the research on recurrence rates of mastectomy vs lumpectomy. My decision for bi-lateral lumpectomy was based on three small lumps all in a row on the left and pre-cancerous calcification on the right. My surgeon didn't feel based on the size and locations that it probably hadn't moved in the lymph nodes.

My margins were clear after surgery, however, because of the location of the smallest lump in the left breast being so close to the nipple it was removed. I have six inch scars on both breasts which are healing nicely. I had no pain only a seroma on the left side where 6 lymph nodes were removed. All tests results and pathology reports indicated that there was no lymph node involvement. Unfortunately the surgeon and the test results were wrong about having cancer in the lymph nodes. Two out of six nodes were macrometastic.

My recovery time was easy, with no pain, and healing was good. I'm due for a CAT scan June 1 to see if the cancer is anywhere else in my body.The next part for me will be chemo, then radiation. Chemo I'm told is much easier now than in the past with 99% of people losing their hair as the major side effect and that both Chemo and radiation can cause extreme fatigue.

Did I make the right decision? I took a gamble and for the most part I think it's paid off. It's such a personal decision. I could definitely live with my breasts. They have never been my most redeeming quality. They don't define me in any way at this stage in my life. The younger you are the more meaningful they are to you. But I do know women who would feel less of a women without them.

Meow13

pink, good luck to you. I hope you never see the cancer again.

BellasMomToo

pink: If the test/path report showed that the nodes were negative, how was it determined that they were actually macrometastic?

So sorry that happened.

jillybeantabby

My mother's pathology came back and it shows no lymph node involvement, thank god! She starts radiation next month I believe,and then hormone treatment. Does anyone know if it's normal for her arm to be feeling tingly/numb/and bruised a few days after the surgery? I figure it must be normal since they removed lymph nodes, but I just wanted to check. Also sorry if this is a dumb question but does this mean that her cancer journey is coming to an end basically? Just radiation,hormone treatment for a few years, and shes cancer free? I'm worried she's going to get cancer again in her other breast tissue and in her other breast, and by the time we found out it'll be more advanced. I think I worry about her more than she worries about herself lol. We haven't met with her oncologist since before the surgery, we'll be seeing him again soon, so I will ask him all of this stuff, but this has happened so fast and its all so new and confusing and I'd like to hear from you ladies. Thanks

Meow13

Great news. I never had radiation but I did have mastectomy and sentinel node biopsy. Yes my arm was weird and still is from time to time. Hopefully, her journey will remain uneventful. Most people move on with no impacts. I just past my 5 year anniversary. As time goes on you and she will relax and get back to normal.

jillybeantabby

Glad to hear you're doing well Meow, I think time will help us relax too.

NotVeryBrave

No - a mastectomy is no guarantee of no radiation. It wasn't a guarantee for me, but looked unlikely. Final pathology showed no cancer in lymph nodes and no need for radiation. A lumpectomy would have meant that I HAD to have radiation.

One reason that I didn't want radiation was that I didn't want to never be able to use radiation on that side of my chest if needed in the future.

Everyone has their reasons for their choice. I often don't write all of mine out because it's a personal choice and probably won't influence others. I was very much on the fence - but you can't stay there forever.

pink_is_my_colour

Bellasmomtoo:

The pathology report after surgery to remove the nodes said it was macrometastic but previous ultrasounds and MRI indicated no lymph node involvement. I suppose that's why the surgeon initially said he didn't think the cancer had spread t the lymph nodes. The original biopsy reports said there was no cancer in either the blood or lymph vessels.

I'm starting to realize that each person's cancer treatment is unique to them.