Decision for type of Surgery

CiaWatni

Will appreciate your advice on this :

I am confused about whether I should go for mastectomy or lumpectomy. My doctor says that both are the same in my case. Chances of reoccurrence are the same in both cases, as I have triple negative breast cancer. But one of my cousins, who is a nurse in Chicago, strongly advising me to go for a mastectomy as she is of opinion that reoccurrence chances are much more in case of lumpectomy.

I just finished my 7th Chemo out of 8th and next will be surgery. As i need to decide which one to opt, will appreciate your experiences / guidance. Thanks in advance.

Beesie

Your doctor and your cousin are talking about different risks.

What is most concerning after a breast cancer diagnosis is a distant / metastatic recurrence. Because this is a recurrence that happens in the body, beyond the breast, the type of surgery doesn't make a difference - your risk is the same whether you have a lumpectomy + radiation or a mastectomy. This is what your doctor is referring to.

Your cousin is talking about local recurrence risk, i.e. a recurrence in the breast. With a MX, your risk of a local recurrence is likely to be a bit lower than your risk after a lumpectomy + rads, although local recurrence risk can vary a lot after a lumpectomy depending on the size of the tumour, the surgical margins and other factors. So sometimes the difference in risk vs. having a MX is large and other times it's small.

Hope that makes sense and helps.

CiaWatni

Hi Beesie,

Thanks for your response and clarification. Now it does make sense. Thanks

moth

Beesie is spot on in advising to think about the two completely different types of recurrences: local versus distant (metastatic). A mastectomy might reduce the chance of local (but never guarantees it because they're *always* some breast tissue left and plenty of post MX people here have had a recurrence in the operated breast). But a mastectomy definitely does not reduce risk of metastatic spread & metastatic spread is the one that kills, so that's the one that's associated with survival rates.

There's a lot of misniformation and emotional response to this topic so it's important to sit back & really consider the evidence, as well as your own preferences.

Also, see this brand new research (published 2021 in Annals of Surgical Oncology).

Lumpectomy is associated with IMPROVED SURVIVAL compared with mastectomy for early stage breast cancer - A Propensity Score Matched Comparison Using the National Cancer Database

https://link.springer.com/epdf/10.1245/s10434-020-...

CiaWatni

Hi Moth,

Sure, will go through the research as suggested.

Since I will be going through the surgery after my last chemo session next month, I am hoping to make the best decision based on this information.

Thank you very much!

MountainMia

CiaWatni, your doctor is a doctor, presumably an oncologist or breast surgeon, who has studied and practiced in specifically this issue for many years. Your cousin is a nurse and does not have that background and is not an expert.

Rasha77

Hi I am in the same dilemma i have 2 Tumors one grade 3 and the other grade 2 in the 2 quarters of my right breast next to each other. I am HER negative and had chemotherapy that made one of the tumors not appearing in the breast pet scan however the other which was grade 3 still appearing but smaller.I had consulted 2 doctors and one had advised with complete breast removal and the other with the conservative approach to remove the tumour and do safety radious around it specifically that depends on the breast size whether it allows the doctor or not.

I had finished my 8th chemotherapy and now I am in the 20 day after my last chemotherapy which makes me in very short time that I should take decision which surgery should I do.

My doctor advised if you are within 30 to 35 years old then complete removal is the advise especially if the breast is small.

Beesie

Rasha, I am so sorry that you find yourself in this situation, especially at such a young age.

From the standpoint of prognosis, the two options - lumpectomy + radiation or mastectomy - are equal. The question is whether a MX is medically feasible, in terms of being able to remove all the cancer while leaving your breast with an acceptable appearance.

Two questions: First, has your oncologist mentioned whether radiation might be required after a MX? Rads is always recommended after a lumpectomy. Often rads isn't necessary after a MX, but there are situations where it is advisable - and from what you've explained about your situation, that might be the case for you. I don't know, but it's important to ask this so that you know in advance and so that it factors into your decision. It would be the oncologist probably more so than the surgeon who should advise you on this.

Second, have you consulted with a plastic surgeon? Before you make this decision, you should talk to a PS about reconstruction options. You might decide that you don't want reconstruction - that's perfectly fine - but if you do want it, you should understand what options are available to you, given your body type and your diagnosis, and you should discuss whether it may be possible to have the reconstruction done (or started) during the same surgery as the MX. This is often done, with the breast surgeon operating first, and then the plastic surgeon coming in and taking over.

Those factors aside, as for the lumpectomy vs. mastectomy decision, take a read through my opening post in the following thread. I created a list of considerations that can help someone decide which surgical decision is best for them. This really is a very personal decision, one that we all look at differently. Hopefully the points here help you understand more about what the future might hold with each option, and helps you decide what is best for you:

Topic: Considerations: Lumpectomy w/Rads vs. UMX vs. BMX