Repeat surgery after lumpectomy with positive margin

Pinkywave

Hi everyone. I have stage 2 breast cancer (T2, N0, Mx), grade 1, Ki-67: 0-5%. ER/PRpositive, HER2 negative. Had lumpectomy on 04/21/20, negative lymph node but got positive margin. I was initially told that my tumor was 1.2cm but it turned out to be 4.3cm and besides my primary tumor (mucinous carcinoma, icropapillary: grade 1), they also found extensive DCIS (grade 1-2). So now I'm considering having mastectomy, hopefully skin-sparing mastectomy, but my surgeon says he only performs total mastectomy and if I want skin-sparing, he needs to refer me to someone else.......If I'm ok with total mastectomy, I can have it done in 10 days. I'd like to explore my options, but I certainly don't want my remaining cancer to spread. So my question is, how long is too long to wait to have re-excision after lumpectomy with positive margin? Thank you!

Beesie

Pinkywave,

Do you know from the pathology report if the positive margin is IDC or DCIS? If it's DCIS, it can certainly wait.

A skin-sparing mastectomy normally means that the patient will be having reconstruction, usually immediate reconstruction but on rare occasions a skin-sparing is done and the reconstruction is later. With reconstruction, a Plastic Surgeon needs to be involved. Both surgeons work together - the Breast Surgeon makes the cut (based on an agreement with the PS on where the cut should be; since you've had the lumpectomy the surgeon would likely use the same incision line) and removes the breast tissue, and then the Plastic Surgeon steps in and takes over the operation to do the reconstruction. With implant reconstruction, either the implant is put in right away or a tissue expander is put in during this first operation and then there is a later operation when the expander is taken out and the implant is put in. With autologous reconstruction, a 'breast' is made out of your own fat and muscles from another part of the body (most often the stomach area but could be the buttocks or thigh). This is lengthy complicated microsurgery and requires a PS who specializes in this procedure.

Is your surgeon saying that he can do the mastectomy but he needs you to engage with a Plastic Surgeon to work with him if you want skin-sparing (and therefore reconstruction)? Skin-sparing mastectomies are very common these days so it would be strange if your breast surgeon couldn't do the mastectomy part of the operation.

Pinkywave

Hi Beesie. Thank you for your quick response.

Margins are positive for both IDC and DCIS. My report says “ Invasive carcinoma, Mucinous and Micropapillary, low grade, extending to multiple margins. Extensive DCIS, low to intermediate nuclear grade, extending to multiple margins” 😞

When I asked him if he can spare my skin, my surgeon just said that he doesn’t do that and if that’s what I want, he’ll refer to someone else.....maybe because he’s a general surgeon, not a breast surgeon? I don’t know....