Is mastectomy always the option after lumpectomy?

tovahsmom

I had DCIS and two lumpectomies on same breast and radiation in 2009. I've just been diagnosed with adenocarcinoma in a spot very close to where the DCIS was. Recurrence? Second primary? I don't know yet. I understand you don't radiate the same breast twice. I will see the surgeon next Monday, the 11th and the waiting, as you all well know, is killing me. Worried the surgeon will say mastectomy this time. Anybody have another lumpectomy and not do mastectomy?

MCBaker

I am conservative. I had an excisional biopsy when I was eighteen. And many doctors fretting about righty over the years. No breast deserves the trauma of being cut into more than once. My immediate decision was to cut it off, even though they originally told me that it was fairly small DCIS. Why mess around with radiation?

I would never allow two lumpectomies on the same breast. I know the statistics, but my gut tells me why keep a mishappen breast and lose one's life in the bargain?

tovahsmom

Thank you for replying MCBaker. I had two lumpectomies, and yes my breast is deformed, because I was diagnosed with ADH, had it removed, discovered there was some cancer, and another doctor went back in to get clean margins - hence the two lumpectomies. I read on this site that mastectomy is the standard of care after you've already had a lumpectomy and radiation. I don't want a more deformed breast than the one I've already got. I'm waiting for appointment with my surgeon and bracing for what he is going to say. I appreciate your replying to my message. I am wrapping my head around the thought of a mastectomy.

Ingerp

I had ALH 10 years ago (with excisional biopsy), then DCIS in 2016 (lumpectomy plus a second surgery to clean up margins), then IDC last year (lumpectomy). I don't know the answer to your question--lumpectomy may be an option depending on size/location. That said, I understand that not having rads as a possible treatment may affect recommended the surgeon's recommendation. Hang in there--hoping for the best for you.

tovahsmom

Thank you Ingerp. Wishing the best for you as well.

Salamandra

I asked my radiology fellow about this when I was trying to decide whether to go through with radiation - I had read that if they radiate an area once, they can't do it again, and I was concerned about sentencing myself to a mastectomy in case of a local recurrence.

For a whole bunch of very good reasons, I followed through with the radiation, which is excellent and well-proven treatment to prevent recurrence.

But it did help that she told me that no, mastectomy after lumpectomy is not a guarantee. She said that it had been the convention of care for a while, but it is not because of the radiation. The dose they give the breast is far lower than the lifetime maximum, so they *can* generally radiate again.

She told me that more and more, doctors are offering second or even third lumpectomies, with general success. She said that of course it depends on the exact nature of the recurrence and the history of the patient. She said that cosmetic impact had also often been a concern, but [some] doctors are now willing to be more open to the idea that some women might prefer asymmetrical breasts/differently shaped breasts to completely losing her breasts.

I don't know really anything at all about your new diagnosis. I had pretty bog standard IDC with about 4cm of DCIS. But based on that conversation it seems to me that if your doctor can't give you a compelling understanding of why he would prefer a mastectomy (and he may be able to!) then it would be worthwhile seeking a second opinion.