When do you look for another BS?

I don't know if many Dr's would be willing to continue doing re-excision after re-excision.  Have you decided on how many YOU want to do?  It might be helpful in further discussion with surgeons.

In my experience, the deal with oncoplasty was exactly as she said - no second chance.  You agree to let them take a big-ass chunk, and if your margins are still not clear, next stop IS mastectomy - because they've smushed the tissue around, as she said. 

My gut tells me you haven't been happy there for a while.  Why don't you do the MRI, and after learning the results think about whether you want to consult with other BSs to see what they have to say.  I doubt wasting a few weeks Dr. shopping will make much of a difference.  You can set up your consults now, b/c I'm sure it will take a few weeks to get in.

My gut also tells me that what she's telling you is very reasonable, though it's not what you want to hear.  Still, I suppose you could push back and insist she do re-excision after re-excision if necessary, until you've had enough or she simply refuses - and THEN find a new BS.

You're right that the microscopic bits of DCIS that keep showing up in the margin are a game changer.  But she does have a new plan, it's mastectomy.  As to whether or not you have a reasonable chance of avoiding one...that's WELL beyond the sort of advice my lay opinion qualifies me to give. 

REALLY sorry it's going so crappily.

I think getting the MRI is important, because it might be very helpful in giving a better idea of how much DCIS is left. The MRI should be an important tool in your surgeon's arsenal, before she uses the knife.  It can provide guidelines on how much more breast tissue to remove next time.  No, MRIs don't always help but they do often enough - and they've been shown to be more effective at showing high grade DCIS - that it concerns me that your surgeon is so wishy-washy on the idea. That's the first red flag for me.  The second red flag is her overall attitude - it seems that she isn't listening to you.  When I went to my 2nd opinion surgeon, I said that I was unsure about having a mastectomy.  He explained why he felt that a mastectomy was probably my best option but understanding my concern, he said that he was willing to attempt a re-excision.  But before finalizing the decision, he had me undergo an MRI, to see what it would show.  It was the MRI that convinced me that my small breast (what was left of it after my first surgery) was full of DCIS and that a mastectomy was in fact my only realistic option.  But at least my surgeon listened to me and did what he could to explore the options.  Your surgeon isn't doing that.  Definitely get a 2nd opinion.  Even if you end up hearing the same thing from another surgeon, you deserve to feel confident in the decisions being made.

Sorry you are going through so much frustration.  My only suggestion is that if you do see another BS, it is probably a good idea to go to someone who is on the staff of a different hospital.

My BS was determined to do a lumpectomy with radiation.  I suggested getting gene tested and talking to a PS.  I got my gene test results back (BRCA1+) and my BS actually told me that my test came back negative!  WHAT???  I was ready to have a bilateral mastectomy, as I didn't want to deal with continued screenings and scares.  Plus, my sister was dx with Stage 2, 8 months prior to me.  I was very happy when I got a 2nd opinion.  I went with the BS and PS that were my 2nd options!  Still very pleased! 

Good luck with your decision.  I would get a 2nd opinion, if I were you.  Doesn't hurt to ask! 

I'd think you'll get the MRI sooner at Columbia, b/c the alternative is to see a diff surgeon first, then have them schedule the MRI (if they'll even agree to one), etc.  An MRI is an MRI, though you could have a second opinion on reading it - for that, the institution you end up at will need to be on a compatible computer system.  I know Sloan is, and I think Cornell is.  Don't think St. Luke's is (though I'm not positive) and not sure about NYU.

IMO, an onc will only address recurrence rates and hormonals.  I can't imagine them fighting a surgeon on surgical decisions.  That's not to say there's no value in talking to one, but I don't think they're going to go to bat for you on number of re-excisions.

As for the MRI - "I told you so."

Kitchenwitch:

     I liked and trusted my BS, but I still wanted a second opinion. I think anyone in our situation should do this.  I took all my films with me to another BS (based at a different hospital) and she spent a good hour talking to me and my husband. She examined me and then basically told me that the first BS was right, and that I had a first-rate team of BS and PS already.  I knew this but needed to hear it from someone else.  She also answered all of my questions about DCIS that I had forgotten to ask the first BS because I was so overwrought with emotion and fear at the time.  Even after my surgery, I had a second (and third) reading of all my slides done by 2 different hospital labs, and met with another oncologist at one of those hospitals just to be sure my oncologist was giving me the correct follow-up treatment.  The point is, the more input, the better. And if you have any doubts about the skills of your team, look elsewhere.- Julie

Kitchenwitch,

I feel so much empathy for you.  I felt my first surgeon was pushing me in a direction that I didn't feel comfortable with.  At encouragement of a doctor friend, I sought additional information.  I saw two plastic surgeons, an oncologist and another surgeon.  The most helpful thing I was told was by the first plastic surgeon who flatly said that if I was seeing him post lumpectomy [which was what first surgeon was talking about], then something had gone very wrong.  When I finally met with the second surgeon [who was in the same office as my first surgeon], something clicked and I knew that was who I wanted.

Technically there wasn't anything wrong with my 1st surgeon but she didn't make me feel confident and her approach might have resulted in really bad scarring with limited options for reconstruction because I would have still needed radiation.  Remember, plastic surgery options post radiation can be limited depending on impact to your skin--some ps won't even consider implants with radiated tissue which may be why you are being told to think about reduction.

You have to go with your heart on this, youi have to trust your surgeon and if you don't, then maybe a different surgeon is the best option however it might also be helpful to figure out if you have sorted out all your feelings about the stupidbreastcancer.  Many places now have therapists on staff who deal only with people dealing with cancer and the feelings that one has when you find out you have cancer.  I know that my appointments have really helped me to deal.

good luck with a difficult decision--many virtual hugs and chocolate!

Kitchenwitch, I agree that an MRI is a good idea if you haven't had one yet however, CAUTION, MRIs can show all kinds of crap that looks serious but isn't really anything.  BS#1 sent me for an MRI which ended up with me needed a CAT scan on my liver AND 2 needle biopsies on my thyroid.  The liver one was because I had "something" which turned out to be cysts but showed on the MRI as possible tumors. 

December in our family stank!  I spent a week or so before Christmas locked in my office in tears wondering if I was going to die.

And it seems an MRIs can miss DCIS entirely.  My MRI didn't show that my DCIS was bigger than thought to be--BS #1 called the MRI results "inconclusive."  Yet the path report after reexcission nearly doubled the size.