lumpectomy (big area) v.s. mastectomy - which one to choose

Jenya

I finished neoadjuvant chemotherapy last week. My MRI from this week shows that I have near complete response. My two lumps are gone.

Neoadjuvant chemotherapy opens a door for me, and now I have two options for surgery.

- mastectomy

- breast conservation surgery (lumpectomy) : cut off 40% of breast (due to widely-spread calcification)

Since calcification is spreading half of my breast, my surgeon suggests mastectomy. However, I try to avoid invasive surgery as much as possible. I am going to meet plastic surgeon next week, and would like to gather some information first.

I wonder if anyone have big area lumpectomy with reconstruction? How is the result? Is it hard to reconstruct breast from big area lumpectomy?

muska

Hi Jenya, you didn't publish your profile, so it is really hard to give any opinion because we don't know any details of your diagnosis.

Speaking of reconstruction I don't think much can be done after lumpectomy but it will be interesting to see what your PS says. Without recon your breast will be disfigured if such a large area is taken out.

Best

Brightness456

I wonder if you could get an implant to refill the area that they take with the lumpectomy? That would allow you to maintain your nipple and some of your own breast tissue so it would feel more natural. I did a little reading on something sort of like this and it seems the fat left behind might sort of spread out to blend in, but that's with a moderate lumpectomy, so probably wouldn't apply to your situation.

I'd definitely ask a few PSs though. I get the feeling they can do a lot if you find a good one

Italychick

My doctor told me I could get my lumpectomy depression filled in with my own fat tissue but I haven't bothered to do anything since it is not really bothering me. But I think that might be an option, just not sure how much filling in is okay, probably depends on the size.

Jenya

Muska: thanks for your info, I added diagnoses.

Brightness456, PS nurse said they can put a small implant - I will meet with PS next week and find out more detail.

Italychick, thanks!

illimae

I didn't want a heavily involved surgery process either and had a lumpectomy with a reduction in the other breast and lift on both to match. It was a little shocking and sad at first to go from a DD to a D but I think I'm over it now and glad to be done with that part. The BS did herpart, then the PS did his, in and out in 4 hours.

muska

Jenya, with stage 3 and triple positive I would get a mastectomy if that is what they recommend. Look what they found in both my breasts after clear scans that showed only scattered calcifications. LCIS was very extensive in both breasts and many positive nodes on the cancerous side.

Please get a second and third opinion and also factor radiation into your recon decisions. Remember after lumpectomy you will be in endless six month monitoring cycle.

You didn't include nodal status in your profile, it is not clear why you are stage 3. It is also not clear why you had neoadjuvant chemo with such a small tumor

Best

Legomaster225

I had great response in my breast with known cancer from preadjuvent chemo. I decided to have a BMX because my breasts were very dense and cystic and I am also very small breasted and symmetry was going to be difficult if I didn't do something to both. Lumpectomy was an option but it would have taken half my breast and I still would have had the cyst issues and constant worry and testing. I didn't want the constant stress and don't want to have to do this again. We were surprised with cancer in my "clean" breast upon surgical pathology. This was after after mammo, a few ultrasounds and 2 MRI's cancer did not detected in my "clean" breast. Thank God we decided to do the BMX. Who know she how long that would have gone undetected.

I would trust my surgeon or at least get a second opinion if you decide to go against his recommendation. My worry would be that you would have the constant testing, biopsies and stress every time you had a follow up You need to decide if that would be ok with you.

pupmom

I had reconstruction after lumpectomy and rads. But it just involved reshaping the bc side, forming a faux nipple, then reducing and lifting the non-bc side. Has worked out pretty well. Not perfect, but much better than before recon. Oh, and I lost about 1/4th of my breast initially. I think I might have preferred a MX if the area had been larger. Best wishes!

ruthbru

I didn't have half my breast taken but did have a pretty large area involved so my story might possibly be helpful. I had a 4 cm tumor removed and then had another surgery where they went back in to get a better margin. I am a little lopsided, but not as bad as I thought I'd be. It took about a year, but the fat shifted around and filled in the space pretty good. Wearing a good bra, you can't tell the difference. Wearing a sports bra, you'd have to be staring directly at my chest in a kind of creepy way to tell the difference. I wanted as little surgery & as short of a recovery time as possible. I did not want to spend any more time dealing with reconstruction and reconstruction issues (but enjoy having breasts). I am 100% happy with my choice. I did rads without any problems, had mammograms twice a year for the first couple years, but then went back to once a year just as before cancer. I would say that if you really, truly aren't sure what to do; you should have the lumpectomy and see how you feel/look. If you are unhappy, you could still have a mastectomy; but once your breasts are gone.....they're gone.

ElaineTherese

Hi!

Outcomes may depend on the size of your breasts. I was/am a C-cup. In my lumpectomy, the surgeon took out a golfball-sized amount of tissue, and it hasn't made much of a difference when we're talking overall size. if you're smaller, the impact will be greater. I'm with ruthbru about a good bra. A good bra can even things out.