Tough Choice lump or mast or bi?

Hi, Lola!

I sent you a Private Message - you're dealing with one of the biggest issues there is with a smaller tumor: lumpectomy or mastectomy, or even a bilateral. I found it bizarre that I "got" to choose - did I suddenly have a medical degree with a specialty in breast cancer?! 

You can't put things back on, but you can always have more removed. Risk of spread (which is what gets dangerous - lumps in breasts don't actually kill you) and survival rate is said to be the same with lumpectomy and radiation or mastectomy. Sometimes you can skip radiation, which a lot of women feel uneasy about, by having a mastectomy. Sometimes you end up needing radiation anyway with a mastectomy because of where the tumor is or because nodes end up positive or clean margins are hard to get, so you can't always skip it by having more surgery. In fact, the only thing you skip with more surgery is future mammograms. Chemo or no chemo, anti-hormonals or none, and possibly even radiation are all dependent on the characteristics of the tumor and its location and whether it has spread to your nodes - regardless of which surgery you choose.

Dr. Susan Love's The Breast Book has great discussions on the pros and cons of both options. It's a personal thing - it has to feel right to you. I'm a "less is more" kinda gal, living in a "more is better" part of the country. Just in your little paragraph, you sound like someone who should start with a lumpectomy and see how it goes...

Coleen

one of my docs said, "when you have a choice, take it!"  sort of like yogi berra and the fork in the road -- take it.  a little unnerving, but it means you get to choose what is right for you, because all the options are viable.  for me, i had a lumpectomy and re-excision for better margins and have no regrets.  my breast doesn't look so good, but has sensation which is/was important for me.  i can always do something to improve appearance or remove any bad tissue in the future.  i wanted to remove what was necessary and no more, but that's me.  many people have other ideas about what is comfortable for them.  you will make the best decision for you, and then go forward without looking back. once you decide what you want, you will have some ease of mind.

take care,

--hattie 

Lola - I am sorry for your dx and am glad you have found this site for support and information.  The main thing to remember is that you have to make a decision that you can live with - listen carefully to your gut feeling then read lots and see if it remains the same then you will have your answer.

My ILC was 12mm after biopsy but MRI said bigger.  My surgeon recommended lumpectomy with rads but from the minute my GP told me I had BC I was going to have a bmx.  After lots of reading about ILC and the difficulty of getting clear margins with lumpectomy and because I didn't want to have multiple surgeries if possible and didn't want rads unless absolutely necessary and because of the stats on the higher occurance rate in the other breast with ILC and the sure knowledge that I could never be free of worry about occurance in the other breast and cosmetic concerns about being 'even' and a whole lot of other smaller reasons, I stuck with my initial gut feeling and chose bmx.  Post surgery pathology found PILC 20mm and LCIS 25mm 95% outside the tumour. The LCIS would not have been cleared by lumpectomy so I would have had to have a re-excision or possibly an mx because of the position it was.  Right prophylactic breast was clear.  I had skin sparing (nipple taken as my surgeon said they are breast tissue so best to remove them) bmx with immediate one step reconstruction (6.5 hour operation) and after several fills the recon was finished with a 1.5 hour op to remove the inflation ports and skin flaps that were left at the initial op to cushion the posts under my arms.  I wasn't taking chances with this nasty disease and NEVER have and NEVER will regret my decision.

Best wishes as you make your way through these terrible times.

Feel free to Private message me if you would like any more information.

Rae

Lola,

You are in the right place, and we ILC's have a lot to say!  I had small breasts to begin with, so the BMX with reconst. was right for me...a lumpectomy would have removed half my breast! and additional  LCIS was found during the surgery.  As you can see by reading the other ILC posts, this is often the case...so please keep that in mind, too.  The LCIS often doesn't show up on Mammo. or MRI (mine didn't). My original tumor was similar in size and grade/stage as yours. Are you doing Oncotype?  That number will enter into your decision as well.  If you have a garden variety, slow growing BC, then surgery might be all you need, if you do a BMX. 

I'm only two years out, but already the yearly follow-ups with Onc. and OB are a drag.  You'll be doing it every 6 months, which keeps it right there in your face.  Will that give you peace of mind or create worry?  Also, with large breasts, how do you feel about them..losing them.

Beth 

I had a lumpectomy even though my breasts were small to begin with.  And nobody would be able to tell because the tumor was small and my breast surgeon was excellent.

I had thought over the options and even thought about the fact that I could get some enchancement if I had a masectomy with implants or reconstruction done, and would also be able to avoid radiation.  But I also thought about losing nipple sensation and realized that this was an important consideration for me.  I also didn't like the idea of not knowing how constructed breasts would turn out and feared that I might be unhappy with their shape.  So I took what for me felt like the safer, less drastic way to go.

Hi Lola!  I am right where you were. I was diagnosed with ILC in the left breast and would not know it was there if I hadn't noticed a dimple since it does not show up on any mammo.  I am having a bmx on Friday.  I have a high family history of BC but BRCA was negative.  MRI showed other potential spots in both breasts and that was enough for me.  I am 49 and have two children and I don't want to be going through this again. My mother died at 46 of BC and her sister was diagnosed at 43.  I am also go have chemo since the tumor was over 1 cm at 1.3 cm.  I will have reconstruction at some point but not during this surgey since I don't want to complicate the chemo treatments.

Dear Lola12: I understand your dilemna. My first tumor was found on a mammogram, confirmed on a sonogram w a biopsy. At that point I was considering a lumpectomy. A few days later an MRI of both breasts found another smaller tumor remote from the first, but on the same breast. That pretty much clinched the mx for me (unilateral) as I would have been left with a 'swiss cheese' breast. I also didn't relish the idea of having multiple surgeries if the margins weren't clear and liked the idea of no rads and less worry, especially about a cancer that is so hard to see. I had the mx in July, haven't yet done reconstruction, and have been getting along OK with prostheses for now. (Couldn't even think of reconstruction in the midst of this.) Didn't need chemo in the end (oncotype was low enough, but needed 3 oncs to convince me of this.) Am on tamoxifen and Zometa and doing well. Wishing you luck. I know how hard all of this is, but you'll get through it. We're here with you.