another surgery... how soon?

JLall

I'm so thankful for these forums.

After a stereotactic biopsy showed ADH in my left breast in 2019, I had an excisional biopsy. DCIS was found and margins were not clear so I had a second excisional biopsy. The pathology reports from each surgery were different, but altogether I had about .8cm DCIS plus a few small scattered foci removed. The second biopsy was considered intermediate grade. Focal, minimal necrosis. Estrogen positive. Second surgery had 2mm margins. I followed this with the usual course of radiation, but was on the fence and postponed a couple of months. No Tamoxifen.

My recent mammogram showed more microcalcifications. I had needle biopsies in each breast. Right breast has a radial scar but otherwise fine (that's new). Left breast has "severely atypical ductal hyperplasia" - "the atypical proliferation focally involves a lobular unit and shows focal marked cytologic atypia and sparse necrosis, worrisome for ductal carcinoma in situ (DCIS)" so they want to do a third excision.

I have surgery scheduled in 2 weeks but asked my surgeon if I can postpone until the end of August. He seemed surprised but said I could. Does anyone here have thoughts about that? I have a lot going on and get overwhelmed by all of this... (I do question if I even need to get surgery, but I know in the end I will.) I have a stressful job / travel coming up and I was hoping to spend some of the summer taking care of my physical and mental health, finally getting some rest, getting more exercise, etc. It's been a hard year. I know it's a small surgery but I feel I would be better prepared for it and probably heal better if I waited. I am still quite bruised from the two biopsies they took on my left breast. I have tiny boobs and am also concerned about the cosmetic outcome and more time might allow me to get more info on this...

I know no one can tell me what to do but I appreciate any thoughts!

LivinLife

It sounds like you have important plans to get yourself back on track, relax, etc. for this summer. Your surgeon said it is all right... You're really only talking about 2 1/2 - 3 months.... give yourself a little more time to think these things through and then decide what you're most comfortable doing.... If you're still uncertain you could ask the surgeon what the risks are in waiting....

STJA16

JLall, I know it is scary. I think you should move ahead with the surgery. You just never know and catching it early would be better and getting at all in in 2021 for insurance reasons may be good also. While you do have the option to wait or move ahead, I think they would have been more firm it it was something you needed to do right now. But again, given the information you provided, I would move ahead. Even with the summer and trying to get all the right things in place, we can always find a reason to postpone.

JLall

Thanks both of you for your thoughts. Still chewing on it but I’ll have to decide soon to make travel plans to MSK...

Jetcat

just had to jump in here to add my experience. I was called back after my first mammogram since treatment for DCIS. There was a delay due to getting my files from another clinic, and by the time they called me I had a death in my family. For lots of reasons, I delayed the follow up biopsy for a couple months. My result this time was DCIS again, Grade 3 but triple negative. There was a tiny area of possible micro invasion Not saying this to scare you at all. I just wouldn't delay getting your diagnosis. Once you know the results, you can then take your time in treatment decisions.

JLall

Good to know, Jetcat. Thanks for sharing your experience.

Ingerp

I've had four lumpectomies over the years and found them such a simple surgery to recover from. And in a weird way it would give you a few days to forget everything else and focus on yourself? Maybe it'd be easier to feel mentally/emotionally better when this is behind you? I dunno--just a thought. (FWIW, I didn't think twice about how I'd look cosmetically. Our breasts are different sizes anyway, right?)

JLall

Thanks again everyone who replied here. I did decide to go forward with the surgery June 15. Even though it's difficult for me to do right now, there will be some relief in getting it over with. Here's hoping they get it all and it's just more ADH or DCIS.

@Ingerp I agree that lumpectomy is an easy, small surgery. My hesitancy to do it now was not really about that. And I'm glad you never cared about the cosmetic results. I see that women here react very differently to that part. I was never particularly attached to my small boobies but was surprised to feel a real loss after the second surgery left my breast looking different. I have gotten used to it though and I'm sure I will again. My surgeon has told me that women with breasts like mine (dense, fibrocystic, some scattered microcalcifications, "a lot going on" as he says) often opt for mastectomy rather than continually going through these suspicious mammograms, biopsies, etc... and that could be in my future too.

Be well everyone and thanks again for your thoughts.