Lumpectomy and radiation vs. Bilateral mastectomy

Psychknowledge

I am 47 years old and was just diagnosed with DCIS and am having difficulty with the decision between breast conservation lumpectomy with radiation and bilateral mastectomy. 

My genetics testing came back negative.  I do have a considerable family history. The surgeon said she can backup either decision with good reasons. I have a son who is 19 months old and a very supportive husband with either choice. I also recently lost 70 pounds which has resulted in less than desirable breasts. 

How do I make this decision?  Here's what I am thinking. 

Lumpectomy/radiation - 

Pros: Somewhat simple day surgery with little pain and down time, keep my own breast, no affect on care of my son and job

Concerns:  Possible recurrence in one or both breasts, future close monitoring and biopsies, tanning or discoloration, decrease in size and firmness, possible lumpiness in breast post radiation, not liking what I see in the mirror at the end of treatment, radiation daily for 4 weeks

Bilateral mastectomy -

Pros: Little/less chance of return, breast reconstruction with better results cosmetically than even pre-cancer, insurance pays

Cons: Extensive recovery length and pain, potential multiple surgeries/procedures for reconstruction, not being able to care for (including carrying) my son for 3 weeks, effect on work and the fact that my job would change possibly (for better or worse - unknown

TIA!

Rrobin0200

it's a hard decision, clearly. It's a personal choice. I chose Bmx. I wanted to throw everything at this beast as possible. Was surgery a breeze? Absolutely not. But it wasn't torture either. I was completely out of commission for 2 weeks, the remaining 4 weeks were light rest. I had my drains removed at the 2 week mark. After the drain removal, I feel like that's when I really began to heal.

Radiation, for me, is something i absolutely did not want to do. I didn't want that running through my body; instead I took the most aggressive approach possible and honestly I have zero regrets.

Neither choice is the “best" way. But again, it needs to be what is suitable for your family, your life style, etc.

No one here can really tell you what to do, I don't think. Just know that whatever you decide, we are behind you 100%.

Best wishes.

And I might add.. I have reconstruction at the same time. Loving my new “look.” Obviously they are not God’s original work, but man did an incredible job almost the same.

MDRR

It really is such a personal decision. For everyone, factors are different. Plus I think you have to know yourself and what you can/want to tolerate. Are you going to worry alot about recurrence? Do you have a good support system and medical team? For me, after my DCIS diagnosis, I opted for lumpectomy and brief radiation. However, the pathology on the lumpectomy tissue came back that it had become invasive. So I opted for a mastectomy (no reconstruction) and I take Anastrozole daily. So far no side effects, but it's only been 8 months. I don't regret my decision. There are no guarantees, and that's what we would like to have. But I think you just need to think about what you will be most comfortable with in the long term. I will tell you that my recovery from mastectomy was pretty easy. While you're limited in upper body activity for awhile, it really wasn't painful at all and within 12 weeks I was able to hike to the bottom of the Grand Canyon (and out!) carrying a 35 pound pack and camping along the way. I sure can't complain about being able to do that! Again, recovery is very personal but once you get your plan in place and look forward, you'll feel so much better.

Keep us posted!

Moderators

The others have said it all so well, but we wanted to let you know we too are here for you. It's such a personal decision, and often a second medical opinion can help. You appear well informed, and now it's weighing all the short and long-term factors.

We're here for you.

The Mods

Ingerp

I'm sure you've been told that the recurrence probability is the same with lumpectomy/rads and mx, right? It is a very personal decision, and one you should make and then not look back on. It was very easy for me--I didn't see taking more tissue than was necessary.

Anonymous

Have your previous mammograms ever reported dense breasts? Can you find out? Dense breasts hide problems from mammos, and I had 5 clear mammos of my very dense breasts over 5 years that didn't reveal the 2 c. tumor in my right breast, which I found on my own. If I hadn't chosen to get all the treatment I could (see signature line below this post) I would have demanded that I get both an ultra sound and mammo every year because of my dense breast tissue, or even asked for a breast MRI every year.

As it was, I didn't want to freak out every time I got a mammogram because of what I described above-false negatives--and so elected to rid myself of as much breast tissue as I could. Was it an easy choice? No. I lost sensation in my breasts, which affected my sex life to a certain degree, and my reconstructions never feel like the originals. But I feel better that I have less breast tissue to worry about.

The surgery itself was a non-event. No real pain, uneventful recovery, drains in for a week or less (not much tissue to drain from after that surgery), and running, hiking, bikram yoga-ing, weight lifting by 3 weeks time or less.

Claire in AZ

Mystic18

Hi,

I am 44, recently diagnosed with IDC. I had ADH and FEA last year on the right and the place they found this year is on the left. I do have dense breasts, family history on both sides. I am choosing removal with no reconstruction. For me, it makes the most sense because I don't want to risk the right side developing into cancer nor a secondary cancer showing up on the left. The 6 month watch and wait is way too much stress. For a year now, this little bug that turned out to be cancer was "Birads 3 - Probably benign". For me, I choose to remove the excess worry. I don't want to mess with reconstruction because I don't want the additional surgeries and potential complications. Like everyone else has mentioned, it's SUCH a personal choice. For the record, I have seen many a comment from those who chose mastectomy (mostly the ones who chose to go flat) and 99% say they have no regrets.

Best of luck to you during this decision. Sending you love from Pennsylvania.

Psychknowledge

I reviewed my last Mammogram report where they identified the area of DCIS and it says "there is dense and diffuse...which could obscure detection of small masses". This worries me of course. 

Thanks everyone for your comments. They are helpful while trying to make this tough decision. 

I also talked to my "nurse navigator" for breast cancer and she informed me that the concerns about the cosmetic result of radiation is not as bad as I thought. I still have concerns (cons) about both procedures. Also I have been told the recovery time of a bilateral mastectomy to return to my desk job is about two weeks. This is shorter than I thought. I would still not be able to pick up my son those two weeks. So much to consider...

Wigging2000

Thought I would jump in with a thought, you have already had some great input.

I had BMX and then reconstruction with implants one week later. I am 17 days out from the first surgery, and 10 from the second. I do work a desk job too. I still have 2 drains and I’m not allowed to drive. I’m hoping to lose the drains on Thursday and also hoping to be released to go back to work/drive on the 27th but I’m not sure. I think recovery times can really vary...so I would advise not getting too set on the 2 week recovery time. Reconstruction can definitely add extra time to recovery.

I chose BMX and I’m happy with my choice; they found more “surprises” after surgery and I would have likely needed another procedure had I gone for the lumpectomy. I was very concerned about recovery time prior to surgery as well but I am so glad I made the choice that I did. I did not want rads or the waiting for recurrence. Rads is a possibility though even with BMX. As is recurrence of course. I’m just glad to have it all gone, honestly.

It’s a tough decision but I think in the end you will “feel” what’s right. Trust your instincts! Good luck!

DeeDeeT

As others have said, it's a very personal decision. It's one only you can make. I have very dense tissue. I also have some additional "mystery spots" on both breasts that are going to be monitored on MRIs, possibly forever.

In spite of these issues, I still was strongly encouraged to by my medical team to go with a lumpectomy. They thought a mastectomy would be "overkill" and in my opinion, they would have been right. I will need extra monitoring, but I'm comfortable with that.

However, it was my decision to make. I'm the one that has to live with results, and personally, as a younger patient (in my early fourties) I'm really glad I decided to go with a lumpectomy.

MBPooch

It's great that you're giving this such thoughtful consideration. I was diagnosed about a year ago and opted for BMX with immediate reconstruction. Not sure if direct to implant may be an option for you but it was nice to only have to go in for one surgery. Waking up having breasts similar to what I had was also mentally encouraging for me. The recovery was not nearly as bad as I had feared. My surgery was Nov 30th, I hosted Xmas Eve and went on a NYE vacation up North. The first couple weeks are challenging but again, not nearly as bad as I thought. I've had zero regrets, I knew I would be overly anxious about every little thing if I didn't treat it as aggressively as possible. I also did not want to go through radiation. Best of luck to you in deciding!