Lumpectomy vs unilateral vs bilateral mastectomy

formy

not a dumb question--I actually remember someone here referencing something just like that from dr. susan love's book--I don't know which one....I would think that your surgeon would know best--based on location, size etc..... 

for me, the lump was just sort of sitting in my breast tissue-- it was very contained--the surgeon made a point of telling me that mastectomy was really not for me, unless I really had a reason for wanting it (ie making sure it never came back), but everyone I knew at that point who had had bc had had lumpectomies and they were all healthy and fine--then I found out that mastectomy does not prevent recurrence, so I was even more comfortable with my decision.  but, with all of that said, in the end, it is really YOU who has to decide--- if there is no medical reason for a mastectomy, but it would make you feel better, then listen to your gut.... I have D breasts, so taking out a 2+cm lump really made almost no difference--you cannot even tell... for someone with smaller breasts, it might have been a different decision.

 everyone has to come to this decision on their own.  My thinking was that my surgeon was not recommending it, nor were her oncologist or radiologist, my breast was large enough for a good cosmetic result and ultimately, for me, I thought that a mastectomy was too much treatment--- as it was I had chemo, radiation and AI's--- I think that is enough....probably more than enough....... 

Keep us posted--never a dumb question!!!!

carol 

What I think I know:  If there is a recurrence, it usually happens near the original site (so maybe there were cells left behind that rads didn't kill) - assuming we're talking about lumpectomy.  If we're talking about mastectomy, then it's all about removing as much breast tissue as possible so there's less likelihood of recurrence. 

One of the breast surgeons that I spoke to (we were discussing reconstruction) said that he saw someone with a really unbelieveably beautiful reconstruction, but as it turned out it looked that perfect because the BS left a lot of tissue behind, which was now "filled with calcifications."  So, I basically got the takeway that leaving tissue behind is a almost encouraging a recurrence (BAD IDEA), not leaving a safe place behind to catch it (GOOD IDEA).

So, probably worth a discussion with your BS.

In the unlikely event that there IS a recurrence (something like a 2% chance, I think), it's usually in the mastectomy scar or in the chest wall.  So, I guess if your area of nasty is close to the chest wall, it's really a conversation worth having with your surgeon.  If it's not near the chest wall, it's probably not as much of an issue. 

But I didn't go to med school, so......

The only reason I can see for someone to have a mastectomy if there is a small lump is paranoia or the inconvenience of having the radiation. Go with what the surgeon recommends. I was lucky to have large breasts and he seems to have done a good job. I have to have chemo/herceptin owing to the HER2 status even though the nodes were clear (followed by radiation etc). He did get good margins and it was only 1.2cm so why chop the whole lot off. My cousin in NZ had a local recurrence but I think that was due to not enough margins.

I was/am concerned about the needle track from the core needle biopsy. I didn't want a biopsy done at all as if you stick a needle in cancer it makes sense to me that pulling the needle out will spread cancer cells. There is no proof this happens but we'll see if it comes back in the same area. I don't think a surgeon would have seen me if I had ultimately refused the biopsy. The one question the receptionist asked me when I tried to make the appt is 'What is your pathology'.

My suggestion is do not panic and listen to what your doctor says.

Hello formykids,

I don't think your question is dumb at all.  I have wondered about that, too.  I had a lumpectomy and  breast reduction (both breats) at the same time.  My breasts were a DD.  But, I did not get clear margins even with the reduction.  I thought the less breast tissue the less to worry about.  Dumb, I know.  It was a huge decision to go back in for a reincision instead of a masectomy.  But that's what I chose and my surgeon got a clear margin the second time. I had readiation but no chemo.  My oncotype was 19.  I'm now on Femara.  I had a new baseline mamo and US at 6 months.  Too much scar tissue to see much.  My next mamo on the breast with cancer is in March.  Will see if there has been a change.  Good luck.