Three Surgeries for this type of cancer

Hi kkaur! Although I'm sorry you have to be here, too, welcome to the board.

I'm 47 years old and was diagnosed in March. I also had a lumpectomy with a "dirty margin" and a re-excision that failed to get a sufficiently clean margin. For me, another excision was not possible, since the margin that was "close" was right at the nipple, which my surgeon explained meant that the DCIS could easily have then travelled along another duct and into another part of my breast. Also, a lot of tissue had already been taken in the two previous surgeries and , cosmetically, I wouldn't have been left with a anything that really resembled a breast. Every case is different though, and there are ladies who have had a successful third lumpectomy. Your breast surgeon should be able to give you a recommendation one way or another, even if he/she leaves the final decision to you. My breast surgeon told me that with the minimal margin that I did have at the nipple (less than 1mm), choosing radiation and tamoxifen instead of a mastectomy would give me an unacceptably high risk of recurrence. She told me that if it was her and she had the same pathology report, she would choose a mastectomy without question.

All that being said, choosing to have a mastectomy is not an easy choice. I consulted with my oncologist, my radiation oncologist and two plastic surgeons before coming to the very difficult decision (for me) to have a unilateral mastectomy. I have had my skin-sparing mastectomy with tissue expander placement for reconstruction. The final pathology report showed that my decision to have the mastectomy was definitely the right one, since they found extensive DCIS branching our from the nipple into another quadrant. I've finished the whole expansion process and just had my surgery to exchange the expander for my permanent implant. I still have one more surgery to go to  reconstruct my nipple, which couldn't be saved because of the close margin there.

Just one tidbit that I wish I had been told before (or that I had known to ask about) ... if you have a unilateral mastectomy like I did, there is a good chance that your oncologist will still recommend that you take five years of Tamoxifen to help prevent cancer from developing in your other breast. Talk to your oncologist about this beforehand, so that you know going in what you are facing down the road. There is also a chance, depending on where your dirty margin is, that you may still need radiation after mastectomy. Discuss the chances of this with your radiation oncologist or your surgeon. 

Like I said before, every single case is different, and what was the right decision for me may very well not be the right one for you. But, in answer to your question on whether a third surgery is normal, it does happen.

Good luck! 

I am grappling with the similar question...a re-excision or masectomy. Tonight I am leaning toward masectomy because it seems to me that going through radiation, however localized, will cause my body more overall harm than removing a breast. But who knows, I may change my mind tomorrow.

Mommy-m and Mom3band1g - Right there with you. I go back and forth daily (doctor appointments are not till next week and then another one on Sept 15, aargh) and at the moment I'm inclined to try to preserve a body part. I would really hate to have the mastectomy and have to have radiation anyway.