5cm tumor. MX or lumpectomy with RAD?

LT4481

Hi all,

I finished my chemo a month ago. Had the mammo and MRI post chemo and my 5cm tumor did not shrink. It lessen in intensity. Plus they have found more calcification. Breast surgeon wants to do mastectomy ( take out the tumor including the calcification) so the cut will be a bit larger that 6.5 cm. Because ratio of the tissue cut to my B size up is large, doctor says it will lead to distortion on breast.

Although I respect my BS, I need more reasoning why it has to be mastectomy. Why can't it be lumpectomy with rads?

1) Is SURVIVAL RATE better with mastectomy than lumpectomy?

2) What is the reoccurence rate for mastectomy and lumpectomy?

3) I am triple positive ER+/PR+/HER2+. Does this play in the decision for mastectomy?

4) Why is 5cm the determination to do mastectomy surgery? Why that number?

5) Since my tumor didn't shrink from chemo, would this mean it's better to do mastectomy?

6) Is mastectomy only for cosmetic reason? If lumpectomy with rad is an effective treatment, why can't all doctors suggest that?

7) Does my calcification findings in post chemo alarming and concerning? Does it mean I have additional unknown floaters around my breast?

8) Did anyone do lumpectomy with 6.5cm cut or 5cm tumor? Do you regret it? Did anyone have to get 2nd lumpectomy or mastectomy because clear margins were not met on first lumpectomy? Can you get reconstruction after lumpectomy? More difficult to do than mastectomy and immediate reconstruction?

So sorry to rant! Any feedbacks/help would be really appreciated.

Mucki1991

IMO If your a B cup and tumor is 5cm would that even leave any actual breast left? You don't have to do a double you can always have the cancer side removed. I'm normally a huge fan of lumpectomy versus a mastectomy but sometimes it just doesn't seem feasible. As far as stats I have seen show there isn't much difference if any at all with regards to overall survival. Yes you can get reconstruction after a lumpectomy however if it is a large tumor the cosmetic results would be better from masectomy .. ( a clean canvas ).

NotVeryBrave

1) Is SURVIVAL RATE better with mastectomy than lumpectomy?

No - all evidence says that the survival rates are the same.

2) What is the reoccurence rate for mastectomy and lumpectomy?

I recently heard that the recurrence rate may actually be slightly less for lumpectomy due to the required radiation afterwards.

3) I am triple positive ER+/PR+/HER2+. Does this play in the decision for mastectomy?

I've never heard of triple positive having any bearing on choice of surgery.

4) Why is 5cm the determination to do mastectomy surgery? Why that number?

I don't think that there is any magic number. It's more about ratio of lost tissue to remaining tissue.

5) Since my tumor didn't shrink from chemo, would this mean it's better to do mastectomy?

Good question. It may have some influence on recommendations for rads. Do you know the status of the lymph nodes?

6) Is mastectomy only for cosmetic reason? If lumpectomy with rad is an effective treatment, why can't all doctors suggest that?

A lot of doctors lean heavily these days towards "breast conserving" or lumpectomy. Cosmetic results vary with both.

7) Does my calcification findings in post chemo alarming and concerning? Does it mean I have additional unknown floaters around my breast?

I'm not sure about the significance of calcifications in this case. You may want to discuss that with a radiologist.

8) Did anyone do lumpectomy with 6.5cm cut or 5cm tumor? Do you regret it? Did anyone have to get 2nd lumpectomy or mastectomy because clear margins were not met on first lumpectomy? Can you get reconstruction after lumpectomy? More difficult to do than mastectomy and immediate reconstruction?

Lots of women end up needing repeat surgeries for margins that are not clear. That was part of the process of determination for me. Also - while lumpectomy is a much easier surgery - reconstruction is more difficult after radiation.

You really probably need to meet with at least one other BS to have this discussion. And throw in a PS as well if you think that you'd like any sort of reconstruction. Sometimes that can be done at the same time as the original surgery, but they would have to be pretty confident of clear margins or it would be a waste.

Good luck. I know it's a really hard decision to make. For some people, it's very clear and obvious what they want. Others - not so much.

Legomaster225

I agree with NotVeryBrave. I just want to add that my tumor did not really shrink MRI and ultrasound had between 2.5 and 4.5cm. It was 3.5 upon pathology. The amount of viable cancer cells was very low. Less than 5% so chemo did work even though I thought it had not. I am small breasted and it would have been half my breast with a lumpectomy. I chose BMX and immediate prepec implants in my original small size. I’m happy with how they look. I did need radiation and found cancer in the other breast as well so it as a good decision for me. Hopefully, the comments above will help you decide what is right for you. Everyone had a different story and it’s good that you’re asking. Best wishes to you💕

LaughingGull

Hi there

My original tumor was 3.5 and it shrank with chemo to the point it was no longer palpable. I am also small breasted, cup between A and B. The post-chemo, pre-surgery MRI with contrast came all clean, no sign of remaining cancer. They gave me the option of lumpectomy+rads vs mastectomy, with the surgeon leaning towards lumpectomy + rads and the oncologist leaning towards mastectomy. I chose mastectomy, partly to avoid future mammograms (which proved useless for me) and biopsies etc in that breast, knowing that chances of survival and recurrence were the same between two options. I thought I would have more peace of mind without having to worry, for the rest of my life, about whatever small piece of the original breast I would have ended up with after the lumpectomy. In the end, during surgery, they found a lot more scattered cancer than they anticipated, and my onc said that originally, pre-chemo, probably my entire breast was full of cancer. In retrospect, mastectomy was the right choice. Also I found the recovery very easy for the mastectomy, really no big deal.

Best with your decision. I would insist that the surgeon explains why he leans towards mastectomy. Guidelines nowadays seem to lean towards conservation whenever possible and if he is leaning towards mastectomy there is probably a strong reason.

LaughingGull