Re-excision after 1mm close margin

Jtjjc5

Hi Everyone,

I guess I am looking for some advice or thoughts/comments on my situation. I had a lumpectomy for high grade DCIS on 12/17, the pathology report showed close margins, only 1mm. My BCS did say I could speak with the radiologist about treatment; however, she recommended a re excision and did not think he would go forward with treatment with such a small margin. I am scheduled for this upcoming Thursday. While I feel she is a good surgeon, she is very abrupt-the first thing she said was 'we could be having this conversation again after this re excision'—thanks, for the encouragement. Anyway, my questions are:

Is there a period of time in which I should wait for the re excision, is this too soon?

I'm considering a mastectomy if the second re excision doesn't provide a 2mm margin, or not?

I don't know, my head is spinning right now...everyone on this board seems very positive, I don't feel very positive.

Anyway, if any of you having been in the same or similar situation, your feedback is appreciated

AmusingSoprano

Hi Jtjjc5,

The sooner the re-excision the better I believe. I had two close margins (0.1mm and 2mm) and chose to have a re-excision because I was high grade with comedonecrosis. There is always the possibility that there will be another close or positive margin, but I from what I've seen on here, it's not all that common. I guess it depends on if the extra they would take would leave things less desirable from a cosmetic POV (if that bothers you).

Are you planning on doing radiation also?

Jtjjc5

Hi AmusingSoprano,

Yes, radiation and tamoxifen. I have small breasts, but the area isn't very big and no the cosmetic aspect would not bother me. When my surgeon said I would need the reexcision, I became visibly upset. Because she made the comment she did, I am nervous now. Although I'm not sure whether she said it because she only wanted to prepare me for the what-if, her bedside manner is not very good. Her partner was my sister’s BCS, she loved him and had great success

DiagnosisDisruption

My first lumpectomy was May 23rd and re-excision was June 12th due to 1 mm margins. The surgeon said they weren't going to find anything, but we went ahead and did the surgery. They didn't find anything more. The breakdown for me was the fact that it pushed my "perfect summer schedule" for radiation back another three weeks into July. I was supposed to finish in July and have August to recover. The best laid plans are the ones that get squashed the fastest.

rockymountaingirl

Jtjjc5, re-excision to achieve better margins after a lumpectomy is pretty common. If you look at the treatment info for me (and many others here), you will often see an initial surgery followed a short time later by another, which often indicates that the margins achieved by the first surgery weren't sufficient. My surgeon explained that when doing a lumpectomy, surgeons try to "get it all" while conserving as much breast tissue as possible, and they just can't tell when doing the surgery exactly where to draw the line. Sometimes, the second surgery still doesn't get it all, and a third try is necessary, although I understand that's not common. If the second surgery doesn't produce sufficient margins, I think it would be completely reasonable to discuss with the surgeon whether it would be better to try again for a good result or just do a mastectomy instead. My own second surgery was successful in producing good margins, but I certainly would have considered mastectomy rather than another clean-up lumpectomy if I had been told that a third surgery was needed. You should do what feels right to you after discussing the alternatives.

I know it's upsetting to start out with a surgery that wasn't entirely successful in achieving its goals, but I hope it will help you to know that many of the rest of us have been in your position, and it is highly likely that the second surgery will take care of the problem.

Jtjjc5

Hi rockymuntaingirl, It absolutely does make me feel better to know a reexcision for DCIS not being unusual. I need to dig deep, understand my diagnosis and simply get on with it—not internalize and worry!!

LisaK12

1. I don't think it's too soon for a second excision -- but that's really up to you and your doctor.

2. My BS told me point-blank that if the second excision did not have clear margins of at least 2-3 mms she would recommend a mastectomy, and that's what she did recommend once the disappointing pathology results came back. I then got a second opinion who recommended a third excision attempt followed by weeks of radiation if the margins were clear on the third excision. I took my time and researched my options before deciding on a bilateral mastectomy with immediate, direct-to-prepectoral-implant reconstruction. I did not have a high degree of confidence that the third excision would have clear margins, and even if it did, I did not want to have weeks of radiation therapy, and I was not a candidate for tamoxifen. I am very pleased with the results of my surgery, love that it was "one and done" with no TEs and an uncomplicated recovery, and the pathology results from the mastectomy showed that it was the right decision for me (DCIS was scattered throughout all four quadrants of the left breast, and precancerous changes were present in multiple areas of the right breast -- none of which had been found on previous imaging).

3. Take it one step at a time. Easier said than done, I know. But my advice is to take your time, get a second opinion if helpful, and then follow your gut.

Jtjjc5

Hi Lisak12,

Thank you for the reply, it's great to hear you are happy and doing well with your decision. I do have a question, were your original markers close margins (1mm for me), or positive (I think that is the right terminology)?