Lumpectomy vs Mastectomy again.

KMo1975

I posted a this question over a week ago, as to whether or not you would have a 3rd Lumpectomy, with no response. So I thought I would try again.

Has anyone had a 3rd lumpectomy for better margins? And how in the long run did that work out? Pros? Cons?

I keep asking my Dr. and myself what is undertreatment and what is overtreatment in Stage 1, node negative.

1.5 cm Pleomorphic Invasive Carcinoma with clear margins.

4.5 cm Pleomorephic Lobular Carcinoma In Situ with close margins.

1 close under 1mm margin after 2nd Lumpectomy, now a 3rd? or BMX?

For those who worry about surgery within 6 weeks, I was diagnosed 15 months ago and still am looking a 3rd surgery.

I welcome any opinions and thoughts.

Thanks,

Kim

NotVeryBrave

I'm sorry that no one has responded to you. I can't speak from experience but had some questions.

Why was your surgery delayed initially? And why we're the two surgeries you've had so far apart?

I would be asking about whether radiation would be sufficient now.

BrinkOfEternity

Sorry no one responded to you. From your post it’s not very clear what’s going on. Did you mean you have 2 tumors close to each other and had gone through 2 lumpectomy to remove them? Which tumor had the close margin?

For me my 2 tumors were 5cm apart so removing both would take out a lot already. I was also worried about having another tumor developing elsewhere on the same breast, so I opted for a UMX.

KMo1975

Being diagnosed the weekend of Thanksgiving and having Dr. appt. over Christmas, we started off pretty slow. Not many have taken a neoadjuvant endocrine therapy path before surgery to shrink the area for a better surgical outcome. It is rather long.

NotVeryBrave: I am asking whether radiation would be sufficient now. However, I still have one close margin for the PLCIS under 1mm. The second lumpectomy did find more PLCIS with the close margins. So basically, it is #3 or BMX. Here is my timeline:

Biopsy: Nov. 2017 Testing: Bone Scan, MRI, Etc. in Dec. 2017 2nd Biopsy Jan. 2018

Neoadjuvant Endocrine Therapy Feb. 2018-Sept. 2018 Lumpectomy #1

2nd Opinions the month of Oct./Nov.

Dec. 2018 Surgery #2

Jan. 2019 Path Report Reviews

Now looking at Surgery #3 And getting a 2nd opinion before I make the decision again.

BrinkofEternity: The tissue removed from my 1st surgery removed 1.5cm PLIC and discovered unseen 4.5cm PLCIS. This was in one area all removed together in surgery #1. PLIC had one close margin, PLCIS had 4 close margins. After surgery #2, PLIC was clear, PLCIS has 1 close margin.

Bottom line, had we gotten clear margins after #2, I would be in radiation now. However, we did not. So again looking at BMX or #3 for margins.

Thanks,

BrinkOfEternity

I'm surprised that imaging didn't find the 4.5cm PLCIS. Would you feel ok with potentially leaving behind other PLCIS that's hidden from imaging? Mastectomy would remove all possibilities of anything else lurking.

Also can you ask your surgeon how confident he/she is to achieve clean margin this 3rd time? If it's less than 90% I would go for mastectomy instead of lumpectomy.

crossh

Hi KMO1975, I was 56 when first diagnosed with a small lump (size of pencil eraser)

My first surgery also had unclear margins, second surgery also had unclear margins, so I switched surgeons and practice, had third surgery finally had clear margins, but no cancer detected. I was left with half a breast and no one could answer why the supposedly unclear margin was not found in the third surgery. This last surgeon actually said that sometimes cancer just goes away by itself. wtf

I was given conflicting opinions on radiation, so I opted out of that as well. 18 months later I went in for reconstructive surgery and ended up having a bilateral mastectomy. There was no way to fix one side without having surgery on the other, so he asked if I ever consider prophylactic BMX. I had not, no one ever mentioned it. But after thinking about it and talking to some family and friends, I figured I might as well just get rid of my breasts and be done will all this constant worrying, surgeries, mammograms, mri's, etc.

It was the best decision I made, wish I did it sooner, I can't believe no one recommended it the time of the third surgery since the last one was really aggressive and basically destroyed my breast anyway. For me the surgery was not that bad. I was out of work for one week, only had pain the first day, then what I would call discomfort for the next couple weeks. Nothing that ibuprofen couldn't fix.

I am 11 weeks out since BMX, had implants put in 5 weeks ago (prepectoral with dermal flap) and I feel great. New boobs look ok, a little smaller and stiff, but they need time to settle. Apparently it takes 3-6 months. I am going back under in a couple weeks to swap them out for a larger size which is a quick 45 minute procedure. My plastic surgeon also recreates nipples (which I had removed to further reduce my breast cancer re-occurrence) and has a tattoo person on staff for the arealoa. I'll probably have this done in the fall.

Hope this helps, good luck on your journey!

KMo1975

Thank you Crossh, it does help to hear your journey! All food for thought and I am weighing all sides to this one. I really appreciate you taking the time to respond and hear your thoughts as you went through the process. After going through what you have experienced, I'm sure you can understand why I am reaching out to hear other's experiences and weigh my options at this point in time.

Bests,

K