Lumpectomy Re-excision vx Bi-Lateral Mastectomy?

KMo1975

I've reached a new cross road. Lumpectomy re-excision to get better margins for a PLCIS (Pleomorephic Lobular Carcinoma In Situ) 4.5cm lesions that was never seen on mammograms, ultra sounds and 3 MRI's. Only found on final path report after Lumpectomy #1 to remove a 1 cm Pleomorphic Invasive Carcinoma that was shrunk via neoadjuvant endocrine therapy.

So, another lumpectomy for better margins on something never seen in the first place?

Or, BMX since now we know this was unseen in the first place?

I have extremely dense breast. My last MRI read " dense breast which could have unseen small masts". A honest truth.

So, those of you who have been done with road a few times. Your thoughts?

To recap:

I was diagnosed in Dec.2017. 8 months of neoadjuvant endocrine therapy to shrink the PLIC mass. Shrunk to 1cm.

Then lumpectormy to remove the seen 1 cm PLIC area.

Upon final surgical pathology report reflected unseen 4.5 cm PLCIS. Needing better margins.

Now: the decision is all mine. Personal for each and everyone of us.

Who believe that lumpectomy vs. mastectomy has no difference in long term survival?

Thanks for your thoughts.

Kim

dakrock

KMO1975 

I have ILC and I had the choice of Lumpectomy or Mastectomy but surgeon said I may have to keep going in for margins and I would also need radiation .  I took his advice and went with the Mastectomy.  I just needed to ease my mind that once the breast was gone I would be okay.   5 months later I had a melanoma on my face and had to have that removed.   Now I have to go back and have the margins made bigger.   I had a large scar on my face and now it will be larger.   Who knows anything about these cancers.   Its almost a roll of the dice.   I just didn't want to keep going back and forth.   Good luck with your decision.     

Anonymous

My dense breasts hid my problem for 5 years and mammos reported incorrectly that I had nothing wrong. I couldn't see myself getting scans and not trusting them, so I went with a BMX. ILC has a higher tendency to be multi-focal (appear in another breast in the future), so that also influenced my final decision. It wasn't an easy one. You lose all sensation in your nipples, and it did affect my sex life somewhat; I still grieve my real, old breasts at times.

Lula73

So the stats say that lumpectomy + rads has same mortality rates as mastectomy with no rads. However, mastectomy has lower recurrence rate. When weighing your options keep the 2nd part in mind. Also keep in mind that the younger you are the more those numbers could shift because the average age of the ladies in those studies that established this data and thought process was around 60. If you’re in your 30’s, 40’s or 50’s, you have significantly more time in your average life expectancy than someone 60 or older (just a fact). And do you really want or deal with a recurrence? Some women are good with doing lumpectomy + rads and they’re ok with the higher stats that they’ll be dealing with BC with again down the road. Others prefer to reduce that risk as much as possible with mastectomy with or without reconstruction (risk reduction of 97%). Before you decide and move forward if your choice is mx, be sure to research all your recon options (implants or natural tissue) if you plan to reconstruct as some have better results if recon is done at time of mx. Here’s a link to 2 excellent resources - 1 that focuses on mx and the other in recon—it’s everything you will hear from most PSs and surgeons + a lot they tend not to tell you. Consider them your crib sheet or detailed cliff notes:

https://www.breastcenter.com/2018/05/01/i-wish-id-known-dr-ordonye-speaks-to-ypo-about-modern-breast-cancer-care/

https://www.breastcenter.com/2018/05/01/i-wish-id-known-dr-dellacroce-speaks-to-ypo-about-modern-breast-reconstruction/

KMo1975

Thank you Lula,

I've watched the videos and appreciate you posting the links. I believe that we spend more time researching the purchase of a car than the time we are given in our Dr. offices to make a life changing and life altering decisions. Researching all options, all angles.

Thank you for taking the time to respond. These are difficult decisions not to be taken lightly.

Kim

KMo1975

Thank you Clairinaz for sharing your experience and your thoughts. I appreciate it.

KMo1975

Bonnie,

Thank you for sharing your experience and I'm sorry to hear that your journey continues to be difficult. I appreciate your response.