Dilema

LAnne47

Hello

I have DCIS.  After a
lumpectomy and a resection, I stil have DCIS. 
Which way to go next is my dilemma. I have a very competent surgeonand
if he can sell me on one procedure over another, I probably will buy into
it.  I have three ways to consider (doing
nothing is not a consideration). 

1. 
Have
another resection and hope he gets it all followed by 3 weeks of radiation and
hormone pills for 5 years. I would probably need a prosthesis to contour to the
right breast. Seems like with so much advancement in breast cancer treatment ,
this would be logical.  Am I being vain
in not opting for a mastectomy?

2. 
Have a left side mastectomy and no radiation and
possibly no hormones..  Leave the right
breast alone snd no reconstructive surgery. Again get a prosthesis

3. 
Have a double mastectomy.  No radiation or hormones.  Also no reconstructive surgery.  I am over 
seventyone years old and a widow. 
My family is very supportative and will support any decision I
make.  If I choose this way to go, it
seems like I’m a copout and doing something very drastic for a small
noninvasive type of cancer. 

If anyone has any comments on this I would truly
appreciate hearing from you.  Thanks for
reading my post

Wigging2000

hello LAnne! My first thought is that if mastectomy (either bilateral or single) can help you avoid radiation and hormone pills...I would heavily consider this. Some women do not tolerate the hormones well. Then again some do fine. I think I would have done anything surgical that I could to prevent having to take the hormones. I definitely did not want radiation either. My mom had it when I was young and the idea of it just scared me. Although I would have done it if I had to. My BMX was pretty easy in terms of recovery. I don’t regret my choice at all.

These are my thoughts. Everyone’s decision is so personal. The right choice is the one you feel best about. Good luck and hugs!

Ingerp

Keep in mind a lot of DCIS lumpectomies require a second surgery--I've read 25-40%. My BS said DCIS is "squirrelly"--you can't see it or feel it and they're trying to minimize the amount of tissue they take so they often have to go back in to get clear margins. I also had a *huge* chunk taken out of my left breast two years ago, but I don't think about it anymore, and my husband says he kind of likes the new breast. This last time was much smaller--you'd never know looking at the breast. Radiation for me was not bad, either time. I recently started an AI but haven't had much in the way of SEs with it. I believe if you're ER+/PR+ you'd need the hormone therapy regardless of which surgery you have.

Salamandra

I don't think it's vain not to opt for the mastectomy. Surgery itself has risks and side effects and less drastic surgery has real benefits. Plus, your relationship with your body, and feeling comfortable and happy in it, that's real stuff. Calling it vanity diminishes it. Each of us has a different relationship with our body and breasts, and there is no point in being judgmental (of others OR of yourself) about it.

It sounds like you have a lot of confidence in your surgeon, so hopefully that conversation will be helpful and clarifying. I went into my conversation with my surgeon assuming a mastectomy and felt such a relief when I learned I could get (and that she recommended) a lumpectomy that it made me realize that I actually did have a strong preference.

My impression is that the most important thing is that you feel empowered and informed to make the best decision for yourself (or confidence in your MD, if they are driving it). Women feel content with both options, and it seems to me that the ones least likely to be happy are the ones who felt pressured into one direction or the other.

MDRR

I agree with the comments -- you need to make whatever decision is most comfortable for you. A good medical team will help you with good education and support of your decisions, and it sounds like you have those. I am one who had a lumpectomy for DCIS but the pathology indicated it had become invasive. So back to the operating room for a BMX and lymph node removal. All along, my surgeon was informative and supportive. Once I had a plan in place it was just a matter of moving forward. I am on Arimidex for 5-10 years. So far no issues with that. Do not question your gut instincts once you have all the information. This is a very personal decision and what's right for one is not necessarily right for others. The main thing is to be comfortable with your choices and your body. Sounds like you have great support from your family as well, so do whatever feels right to you!

VegGal

Double all the way for me. No nasty radiation, which is really scary to me.  I did not want to risk heart, lung and rib damage. No ongoing meds, which often seem horrible. No more mammograms and the anxiety they brought me. 

Going double is not a cop out. It's a really smart decision, in my opinion. 

SDWoman

I agree it is a very personal decision and what makes sense for one might not make sense for another.

I am 48 and just had BMX with reconstruction last Friday for DCIS. So far the recovery has not been bad. I opted for BMX for a few reasons:

1. 3 to 5 weeks of radiation and 5 years of hormone blockers seemed to be alot. In my mind it would be years before I could put this behind me and not be reminded of having cancer.
2. I have a very extensive family history of breast cancer so was considered high risk of recurrence
3. I wanted to avoid the anxiety of future mammograms/callbacks/biopsies. Especially since I have so many years left.

My pathology report came back with no surprises. An oncologist will have to confirm to be sure, but I should need no further treatment. It is very liberating to know that I'm done.

MBPooch

I also did a BMX with direct to implant for DCIS and Pagets. Recovery was much easier than I imagined and most days this time in my life last year is a distant memory. I wanted to treat it the most aggressive way possible, not wondering if something had been left behind. Not have to do radiation or worry about hormone blockers. My pathology also had no surprises but I'm certain I would have second guessed every little thing had I chosen a different route.

Benaya

You might want to read about some of the research Dr. Laura Esserman at UCSF is conducting on the treatment of DCIS. I've attached an article & you can google her name to find more.

Good luck in whatever you choose to do!

https://www.nytimes.com/2015/09/29/health/a-breast...

LAstar

Hi, LAnne47 --

Sorry that you find yourself with such lousy options. What grade is your DCIS?

Some thoughts after having been in the same boat:

* A 2nd reexcision is an easy recovery if it puts your mind at ease that you have done all you can to avoid MX.

* An MRI might help you determine the extent of the DCIS if it is grade 2 or 3 (citation out there). However, after 2 LEs, you might have a lot of swelling that might be hard to interpret.

* A UMX without reconstruction would not be a bad recovery. I've heard as fast as 2 weeks!

* A BMX has higher risk of complications (it's just 2 UMX's) and both of your arms are shot. It's nice to have one good arm and some areas without numbness. I had BMX due to a suspicious MRI (apparently false positive) and a desire for symmetry, but I think I'd have opted for UMX if I'd had all the facts.

* If you can have your BS mark, but not take, your sentinel nodes, you will have only a small risk of developing LE. I have LE after losing only 3 nodes, and it is a long-term hassle. In the unlikely event that invasive DC is found during the MX, they can go back and take the nodes.

I wish you peace with your decision!

MCBaker

I am 68, and unlikely to (re)marry. I reviewed the pages here, and opted for UMX. Great love for lefty, feeder of my babies, and disgust with righty, always troublesome. Very concerned about unequal weight hanging off my shoulders and causing back pain, so opted for reconstruction. Final pre-surgical diagnostics eliminated the possibility of lumpectomy.

I watch with amazement when people report multiple lumpectomies. You see, I had a lumpectomy(biopsy) on righty when I was eighteen.