mastectomy or lumpectomy?

Mastectomy..... I really do feel that this is the best route.... I hear.... of way. way, way too many people having reoccurance with only a lunpectomy.... good luck... HUGS!!

I forgot to add that a mastectomy with reconstruction is a major surgery that usually takes 13 to 15 hours and a long recovery.  Yes, if it is necessary then no question.  But if it is not, then I would think about it and be sure.

Caren

The questions are for all your doctors, not just the medical oncologist.  They each have a different perspective, so you may get very different answers from different doctors depending on their area of expertise.

Ask what how the decision to do mastectomy vs. lumpectomy will affect the recommendations for additional treatment (radiation, chemotherapy, hormonal therapy). 

Understand that doing radiation now makes successful reconstruction more difficult if you choose mastectomy in the future.  Not impossible, but more difficult.

Each additional treatment carries its own set of risks and benefits.  Know what those are before you make your decision.  You may find some risk/benefit ratios quite tolerable, and others unacceptable, and your tolerances may not match someone else's. 

Ask about your chances for recurrence with each choice. I was told my local recurrence rate is less than 1% with the bilateral mastectomy, and about 12% with lumpectomy and radiation.  Yours may be different, but ask.

A good question to ask yourself is how you would feel if you choose lumpectomy, and a year from now, IDC shows up in the other breast.  Would you be glad that you've had that time with your natural breast, or mad that you have to go through this again?

Every decision is yours to make.  Your doctors, family and friends can make recommendations, but they can't force you to follow them. 

Wishing you good luck, and peace with your decision.

Remember that a masectomy is a serious surgery, with risks of it's own, and reconstruction means more surgery with potential SE and problems also (check out the reconstruction threads). Unless something genetic is going on; a lumpectomy and rads give you EXACTLY the same odds of being OK as a mastectomy. Just something to consider.Good Luck! Ruth

I agree with you ruthbru.  Everything I have read and been told says that a lumpectomy PLUS radiation is as effective as a mastecotomy in terms of recurrance. I went that route but also had chemo because of my tumor size and grade even though my oncotype was pretty good...............17.

Again it is such a personal decision and one we need to make ourselves when we are comfortable with all the info we have gathered.  In most cases there is no rush, so take the time you need.

For me, I did not want a surgery that may very well be unnecessary, and the surgery and the recovery (mostly the reconstruction) were a big deal.  It was also explained to me that there is no way to remove all the breast tissue so there is still risk.

After I completed all my treatment and I was about a year out my onc talked to me about a prophylactic bilateral mast. because he felt it would take future worry off my plate.   After second opinions and more research I decided against it.  The interesting thing is the last month or so I have been dealing with some "issues" that have caused much worry, BUT none are at the breast site.  It involved my ribs and my liver so even if I had had the mast.  I would still be doing this worry.

Life is different forever after diagnosis.   Every little thing that comes up in bloodwork or an exam,  or a little ache is now a big thing that has to be investigated to make sure it is not cancer related.  It is our new life.  But the positive side is I am being looked at, tested, and probed so much that any other health issue that comes my way will be caught early and not linger.  So maybe we are very lucky in some ways.

Caren

Thanks tgood02.  Actually all testing has proven negative for disease so far.  There was a question about a swelling in my lower rib but after xrays and a bone scan they are saying it is just my asymmetrical anatomy.  I also have elevated liver enzymes but a liver ultra sound although it showed some "things" , it did not show any lesions or malignancy.  I was just making the point that had I opted for the prophylatic bmx I would still have had these worries, so I have not second guessed my decision so far.  I do know that there would never be a question about going forward with a bmx if anything ever shows again in a breast...................that's for sure.  But for now I am hopeful that I never face that decision.

Caren

It's a very personal decision.  My surgeon told me to do a lumpectomy and then I got a second opinion who told me that he would not recommend a lumpectomy and radiation on the left side for a 33 year old because of risk of heart damage.  Also rads can cause problems if reconstructing. I chose a mastectomy and I am so glad I did.  They thought I only had an IDC lump but it turns out the pathology indicated extensive cancerization of the lobules and several separate areas of DCIS that DID NOT show on any of the scans.  Getting a mastectomy probably saved my life.  If I got a lumpectomy I would not have known about the DCIS.  I think they say the 'survival rate' is the same, but what about 'recurrence rate'?  I have seen so many women get recurrences after lumpectomy, yes, they may survive their second bout with this disease, but who wants to do this more than once?  Again, it's a personal decision and whatever decision a woman makes is right for her.  My decision was right for 'me'.   

Breast surgeon and two different oncologists told me that a lumpectomy with rads is just as effective as a mastectomy.  But there are so many other factors and unknows that in the end it is so individual, isn't it?

I think it is great that we can share from  our own perspectives and experiences; and hopefully help others who are going through this difficult journey (which I think is why each of us is posting). Maybe something one of us contributes will be just what someone needs to hear.  There aren't any right or wrong answers; just people trying to do the best that they can. All my best to you, tgood, and everyone else too! Ruth

As someone said above - lumpectomy and radiation is the same - just as good as mast.

That's interesting but not what my oncologist has told me.

Also check off your questions as they get answered so you don't miss anything. And keep writing questions down as they occur to you between appointments. I still do this, and also get a copy of all your blood work, tests, reports etc. Even if you totally trust your team, it is good to have the information in your own hands.

 I think the key is that the rate of distant recurrence is identical, at least last time I checked. (As I am writing this, I do want to point out that those numbers may be different for triple neg, where there is some benefit to going the bi-lat route.)

And yes there are people who have the masts and still recur.

I hate to say this, but you also have to consider pain. A percentage of people seem to have chronic pain with a mast.

You can always have the lumpectomy now, and have a bi-lat mast later on, though the rads might make reconstruction more difficult.

I think the biology of your cancer is the most important factor, not the procedure. If your docs are saying go with a lump, I would give that serious consideration. 

At the end of the day the choice is personal.