Recurrence after lumpectomy and radiation- mastectomy next?

panky228449

Almost four years ago I had an almost 3cm papillary carcinoma removed (two lumpectomies- first lumpectomy had positive margins, plus showed DCIS so had a second lumpectomy along with breast reduction on left, healthy breast so they would match) followed by 3 weeks of radiation on my right breast.

I took tamoxifen for about a year and a half, but developed a large mass on my right ovary that was being fed by the tamoxifen. Obgyn and oncologist and I decided together to stop the tamoxifen- the ovary was monitored for about four months and the mass gradually disappeared.

I felt a lump in my right breast (upper right quadrant this time, almost under my armpit) and had a core needle biopsy last Friday. Labs came back today and I have papillary carcinoma again (along with a suspicious lymph node that is being biopsied tomorrow). Hormone receptor info isn't completed yet.

I have an appointment with my surgeon next week and am trying to gather info before my appointment.

Here are my big questions: I'm thinking it's just better to go with a mastectomy this time and maybe even do a bilateral with reconstruction and just be done with this. Because of my previous cancer and radiation, would a mastectomy be recommended anyhow? Because of the previous radiation, would I need to do flap surgery? I read that it's hard to do implants when you're previously done radiation? I am 55 years old.

Thanks and I would appreciate any info from someone's who's had a similar experience. I really appreciate this community (again!).

xo

jessie123

Panky --- So you are saying that the tumor is in the same breast as your first tumor? I was told by my surgeon that I can't have another lumpectomy and radiation if my cancer comes back in the same breast. I think it has something to do with the radiation. If it happens to me I'll do the double mastectomy. My surgeon said that she wishes her patients would have one breast off and the second off 3 months later as it is easier on the patient. It's a thought.

panky228449

jessie123, that's my understanding too. When I had my radiation last time, they said (at the time) that I wouldn't be able to have another lumpectomy if it came back (and yes, it's back in the same breast).

Barbara1954

I am in the same position and wondered if the surgeon will be saying mastectomy and not lumpectomy this time, so thanks for your responses. I have ANOTHER QUESTION though. My first tumor (almost 5 years ago) was HER2-positive so it was recommended to get TCH treatment, which I did. I'm wondering if my first tumor was HER2 positive will this one be also (I don't have my full pathology results yet)? Has anyone had this situation?

panky228449

So I've met with my surgeon and she said mastectomy for sure, plus ALND. The lymph nodes biopsy came back positive. I'm going to do a bilateral mastectomy. Not sure yet if I will need chemo or radiation to lymph nodes as well. They will know more after the surgery. I had encapsulated (supposedly!) papillary carcinoma the first time which has come back in my lymph nodes. Mine is ER+ only.

KBeee

Hoping surgery goes well. Mastectomy and ALND sounds like the standard in situations like yours. I would talk with a plastic surgeon about the best reconstruction options.

panky228449

Thank you KBeee! So what I ended up having done is a bilateral skin saving mastectomy and ALND. They did reconstruction at the same time using Alloderm and implants. I'm home now recuperating. Looks like I'm going to have targeted radiation to the lymph nodes that (hopefully) won't impact the implants.