Mastectomy or radiation

I am 54 and have just been diagnosed with IDC. My choices now are mastectomy or radiation. I have heard pros and cos to both. Preferences?
Comments
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I just met with a plastic surgeon and dealt with this issue. in his opinion, you get one or the other, not both.
With DCIS you get radiation if you get a lumpectomy. The goal of the lumpectomy is to leave you with an breast that looks largely the same as before you went in.
If a lumpectomy will leave you with mega scarring its better to go with a mastectomy because radiation damages the tissue which can make it much harder to do reconstruction. In his opinion you got better results reconstructing from a mastectomy.
All of which frustrates me because my 1st surgeon recommended an approach that would be a lumpectomy with radiation with plastic surgery.......grrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr
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I'm also 54 and was diagnosed with DCIS for the second time. When diagnosed for the first time in winter of 2007, I had a lumpectomy followed by radiation. My surgery came out with clean margins and my nodes were normal.
Radiation was not that bad, I continued to work until the last week when my doc insisted I take some time off. I did not have any major skin issues, just something like sunburn. Unfortunately they found another patch of DCIS in October of this year. A lumpectomy is not an option this time and due to the numerous biopsies (over 10) I've had in both breasts I've decided to do a double with reconstruction and get it over with.
If I was to do it over again, I would go the same route. Since it was also stage 0, I had a good chance of no further issues and wanted to "keep what I had". They say only 10 - 20% have a recurrence but, I guess I fell into that group
. The only downfall I can see now is the reconstruction on the radiated breast. I'm going to try expanders as my PS said my skin is in good condition, but normally this can be an issue if you have to have a mastectomy and Reconstruction in the future. I hope this helps - or if you need any other info let me know
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You have stage 0 cancer and the cancer is grade 1. You are over 45. If it was me, I'd choose a lumpectomy plus radiation. I'm 47, and have DCIS grade 2, multi-focal. I did have a lumpectomy and have to have re-excision because the doc didn't get clear margins. I am fighting hard to avoid a mastectomy. I know that I would be very upset, sad, depressed if it ends up that I have to go that route but I don't fault anyone for choosing that treatment. Please think long and hard before you allow them to cut off your breast, for Stage 0, Grade 1 DCIS.
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I believe there is some confusion as to your dx..........if your pathology report said that your tumor was IDC, I don't understand how it could be staged as Stage 0............it should be a Stage 1. Stage 0 tumors are usually for those designated as DCIS.If your tumor is indeed IDC (invasive) then the decision isn't any less difficult. It's a very personal decision - my IDC tumor was small (just .9cm) and a Grade 1, but I didn't want to deal with radiation at all and I wanted to reduce any chance for recurrence - so I went with a mx with immediate recon. Afterwards, the results of my FISH report showed the tumor to be highly HER2+ so I felt even more justified in getting the mx, even though I experienced numerous complications from the reconstruction.
Do you have the complete pathology report from your biopsy? Is your tumor ER/PR or Her2 positive? How large is the IDC portion? All this will help you make your decision..........if necessary, seek out the second opinion of both oncologists and breast surgeons. Good luck with everything and keep us posted!
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Dear lmtweedles:
Not to diminish your situation but I agree with VinRobMom, If you actually have DCIS Grade 1, you are in the lowest risk group for recurrence and a mastectomy sounds drastic - as does radiation, quite frankly, depending on the size of lesion. Sounds like you need to consult medical professionals - a surgeon (or two) and a radiation oncologist (or two) before you make any drastic decisions. -
I second VinRobMom and Janets1 advise. A mastectomy is permanent and can be emotionally devastating. I know.
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Imtweedles -I read your profile and am even more confused since you stated there that your tumor is DCIS. There's a world of difference between DCIS and IDC (the latter is invasive with a risk of mets).........still there are plenty of women who had DCIS who needed mastectomies due to the size of the lesion and that the surgeons couldn't get clear margins. It's not just the Stage of the tumor that's relevant.........please double-check your pathology report and be sure you know the difference between DCIS and IDC before making any decisions.
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In the world of DCIS, size matters. If you have a large patch of DCIS and are not large breasted, when the surgeon removes the lump, you may be left with a very disfigured breast. Since the recommendation/guidelines require radiation with lumpectomy, the process may leave the patient needing plastic surgery for a lumpectomy on radiated tissue ---because of scarring or loss of volume--which is more complicated and, as I understand it, has greater risk of not getting a good [visual] result.
That said, I suppose if was bigger on top with a large patch of DCIS, you could get a lumpectomy and then, in lieu of plastic surgery on a radiated breast, get reduction surgery on the unradiated breast.
For me, the more troubling issue is what would have to be done to repair the "bad boobie." I have had abdominal surgery in connection with a hysterectomy. RECOVERY STANK and I had an absolutely AWESOME surgeon who left a little teeny tiny incision. I look at what needs to be done for a TRANS flap or a DIEP and my stomach goes flipflop. I am just not willing to spend that much of my life [ie time with my kids] essentially recovering from this stupid DCIS--I want to be DONE.....
But its a personal choice.
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I vote mastectomy! Life is the most precious gift of all. Boobs that carry cancer are not worth it. Im on your side no matter what. Its a big step. Keep talking and remember you have support here. Thinking of you. Sending hugs!
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I'm 55 and facing the same choice... hard isnt it? I've had 2x surgery which removed my DCIS but was offered a mastectomy after that. I chose the watch-and-wait route and now (18months on) have a 7mm mucinous carcinoma. The surgeon is offering me lumpectomy with radiation & ...gut reaction/clutching at straws/within 5 mins of diagnosis... I said "ok". Its booked for 4th Feb but I'm having second thoughts and am waiting to speak to the BC nurse and hopefully come to an informed decision. I dont fancy the extra time in theatre/hospital but I dont fancy the rads or having to go back either. Lets face it, whichever we choose, we'll probably always wonder if we were "right". There really isnt a "right" choice - just have to pick one I guess. There's a lot of weighing up (no pun intended!)
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I had BMX without reconstruction and rt. axilla dissection and will also be undergoing RADS in February. They originally found a positive lymph node in the mediastinal area- which is in the middle of the chest that they wanted to radiate-- AND now that there were so many nodes positive in the axilla they are going to radiate chest wall-axilla-mediastinal and subclavicular areas! I assume you never know what the full game plan will be until after surgery?
After Chemo and before Surgery the PET scan showed "no cancer" in the breast or axilla area and only a small area lit up in the mediastinal lymph node. After Surgery-- the pathology report showed (2 small tumors in one breast that were less than 1cm and 12 positive lymph nodes)! These findings even surprised my Oncologist. Maybe since the tumors were less than 1cm they didn't lite up on PET????
Saying all that-- I'm so glad I went with the BMX-- no more biopsies and mammograms! The only thing I find difficult is finding clothes for me to wear when not wearing a prosthesis. This is my personal decision and I know you will find that you will make the right decision for you
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