Oncologist & Surgeon disagree?

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BonnieSF
BonnieSF Member Posts: 101
edited June 2014 in IDC (Invasive Ductal Carcinoma)

I had a lumpectomy and SNB 9/4/09. The pathology report took a long time to come back. The surgeon was on vacation and the oncologist gave me the results. He said that the the margins were positive in three places and that he was recommending mastectomy. The surgeon came back from vacation and he recommended re-excision. His reason was that if they get negative margins, that would mean less surgery. 

At first I was happy about the surgeon's recommendation, but now I'm confused about the two different recommendations. I've decided to wait a day before I ask any questions, but I wondered what you folks think about these differing recommendations.

Thanks very much,

Bonnie

Dx 8/4/09, IDC/DCIS, 1cm, Stage 1b, Grade 1, 0/2 nodes, ER+/PR+, HER2-

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  • sheila888
    sheila888 Member Posts: 25,634
    edited October 2009

    Hi Bonnie... I also had a lumpectomy with no clear margins. And had a re-excision everything was clear. The only difference was that I didn't have an oncologist at that point. I believe surgeon decides about surgery and oncologist decides your treatment.

    I am just writing my own experience.

    Good Luck to you. I think BS knows more after all that is his specialty.

    Did you ask your onco why he is recommending a mastectomy?

    Smile Sheila

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  • HelenaJ
    HelenaJ Member Posts: 1,133
    edited October 2009

    Hi Bonnie,

    Perhaps the surgeon believes he can make a re-excision and get clear margins without compromising the overall effect on the breast.  I had quite small breasts and did not get clear margins during my lumpectomy - there was no way the surgeon could save my breast without it looking very deformed. 

    Usually lumpectomy is followed by radiation, less surgery perhaps but more treatment, so make sure you speak to both your surgeon and your onc and get the full story before making the next decision.

    Hope you get some more information soon both from your doctors but also from the lovely ladies here.

    soft hugs

    Helena

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  • London-Virginia
    London-Virginia Member Posts: 851
    edited October 2009

    Hello there - sorry you have had this difficult experience.  Surgeons by nature tend to be failry agressive in their approach to things (you couldn't do their job otherwise, I think) so if the surgeon feels pretty confident that the margins can be achieved, that sounds good news.  Not a nice experience having to do it though. 

    Helena raises a good point concerning the cosmetic outcome.

    I guess to a degree this may come down to breast size overall.

    I had a lumpectomy (but with clear margins as I am big breasted) and am happy with the outcome and results. 

    all the very best to you -

    xxxxxx

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  • hollyann
    hollyann Member Posts: 2,992
    edited October 2009

    Welcome to the club nobody wants to join!....What was your pathology report?...Maybe the oncologist was recommending mastectomy based on the pathology report......I know with me I went with bilat masts because of family history but possibly the oncologist says mast because of path report....Good luck to you....

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  • BonnieSF
    BonnieSF Member Posts: 101
    edited October 2009

    The club no one wants to join! Ha! That's for sure!!

    As to why the oncologist recommended mastectomy: I recall that he thought that because the margins (DCIS) were positive on three sides (lateral, inferior, and anterior) that the re-excision area would be too large.

    For the IDC, there were 1mm margins posterior and inferior, and and all other margins widely negative.

    The oncologist said that there was a lot of cancer in the specimen. The surgeon agreed, but said they got pretty much all of it at the lumpectomy.

    The surgeon said that if I were smaller-breasted, re-excision would not be an option. I'm medium-breasted. It's been 4 weeks since the first lumptectomy and the breast does not look too bad. 

    I'm starting to feel more confidence in the surgeon's judgement. He sees this stuff all the time. Plus, a lumpectomy is so much easier than the mastectomy and reconstruction, it's worth a try to see if it can be successful, right?  A successful lumptecomy will mean radiation, and now I need to learn about how radiation affects the cosmetic results. sigh...

    Bonnie

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  • koshka1
    koshka1 Member Posts: 678
    edited October 2009

    Hi,

    I would listen to what the surgeon has to say.  As surgeons spend all their time cutting stuff like this out.

    I too had a lumpectomy and had dcis at the margins..my idc was 1mm and 4mm.  I had the re-excision and my margins after that were clear.

    My surgeon, prior to the reexcision called the pathologist and had him have another look at my lumpectomy sample and he gave her a clearer report on where the left over cancer was to guide her surgery better.

    A year later mri and mammo are both good.

    Anyway..let us know what you decide.

    Hugs..Kosh

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  • Beesie
    Beesie Member Posts: 12,240
    edited October 2009

    It sounds as though the oncologist is making a judgement on what he thinks the surgeon can achieve, and the surgeon is telling you want he thinks he can achieve.  Since the question is about surgery, I'd say that the surgeon's opinion holds more weight.

    So I think that if the surgeon believes that he can do a re-excision, get clean margins and have good cosmetic results, there is no reason to not try that approach, if it's your preference to have a lumpectomy rather than a mastectomy.  However the one thing to keep in mind is that with the number of close margins that you had, it is possible that you could have this second surgery and clean margins might not be achieved.  If that happens, then you will need to have the mastectomy.  As long as you are okay with that possibility there is no harm in attempting the re-excision and hoping for clean margins.

    Good luck! 

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  • LRM216
    LRM216 Member Posts: 2,115
    edited October 2009

    I too had a lumpectomy and 2 margins unclean.  Had a re-excision two weeks later, which was decided by the breast surgeon as I had yet to see the oncologist.  If she did not get clean margins she was going to remove the breast, but we did get large clean margins.  Hope that helps a bit.

    Linda

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  • BonnieSF
    BonnieSF Member Posts: 101
    edited October 2009

    Thanks for all the responses - these help it all make sense. I contacted both the oncologist and the surgeon again and am now scheduled for a second lumpectomy on Oct 29. The surgeon figures it's worth a try to go for negative margins. I am glad to have a chance to avoid mastectomy. 

    Still have no idea what to do regarding reconstruction, if it comes to that. I have an consultation with the plastic surgeon next week.

    Bonnie

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  • FACECRAFTER
    FACECRAFTER Member Posts: 1,092
    edited October 2009

    Bonnie:

    Why don't the surgeon and the oncologist talk to each other and take you out of the middle?  Whenever I have two differing opinions, I make them talk it out and arrive at a decision.  That's their job.  Your decision may be right one, but I'd like to see the two of them talk it out--given that you have faith in both of them.  JUDY

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