Stage IIa: lumpectomy or mastectomy

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medinorth
medinorth Member Posts: 67
edited June 2014 in Stage I Breast Cancer

I've been reading the forums and it seems most people that are stage IIa have had a mastectomy, and not a lumpectomy which is what I had. I am worried now. Please tell me why you had one over the other.

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  • lago
    lago Member Posts: 17,186
    edited January 2011

    sorry I'm a IIB but I wasn't given a choice do to size of my tumor and the small size of my breasts. Just to let you know that the survival rate is the same for mastectomy as lumpectomy. There is a slight higher local reccurance with lumpectomy. You should have your doctor discuss this with  you. There are other things specific to you case that you also need to understand as far as risk including 5/7 nodes, HER2+ and ER/PR- , your age Fully understanding these factors might help you with your decision.

  • beetle25
    beetle25 Member Posts: 40
    edited January 2011

    Medinorth:  Like you I had a lumpectomy, after I did alot of research I had found that there really was no difference in the survival rates between a mastectomy and a lumpectomy.  Sometimes when I read the posts that others have written and see that stage IIa had mastectomies I also worry a little but then I remember the research.  But like lago stated if you are having concerns bring them up to your doctor I am sure that he/she gave you their recommendations when you were deciding on what to do.

    hugs

  • momand2kids
    momand2kids Member Posts: 1,508
    edited January 2011

    Hi

    I had a lumpectomy, chemo and radiation--- according to everyone on my medical team, this was the course to take given my age (48) stage, grade, and characteristics of the tumor (it was very discrete-- not connected to anything-- kind of floating in my breast close to the skin......

    I also had a size D so therefore had some room---- cosmetically you would never know..... I think it was the best decision, but I also had all that treatment after the surgery.... so I felt like it was a good combination.

    Please talk to your doc again--make sure you understand the reasons why you had the lumpectomy---- it is important to feel good about the decisions you made.  I am assuming that you will be having some treatment?  Don't forget that the treatment also helps...... 

  • medinorth
    medinorth Member Posts: 67
    edited January 2011

    Thank you lago, beetle25, and momand2kids

     I am under 30. According to the doctor my treatment will be TCH x6 (H for one year) and rads.

  • valeriekd
    valeriekd Member Posts: 287
    edited January 2011

    Hi, I had a big tumor and was told by the top team @ Mass General in Boston that there was no difference in mortality or recurrence so I opted for a lumpectomy and have done just fine-good luck to you!

  • misfit
    misfit Member Posts: 60
    edited January 2011

    Both surgeons I saw said lumpectomy and rads, so that's what I went with.

    Edited to add: plus chemo and Herceptin

  • cookiegal
    cookiegal Member Posts: 3,296
    edited January 2011

    A recent study showed lump+rads had a better survival rate than mast w/o rads. I'm a 2a and had a big ol' lumpectomy.

    Another recent article suggested it really is important how clean your margins are.

  • D4Hope
    D4Hope Member Posts: 352
    edited January 2011

    I had both my breasts removed. jhen I had an MRI it picked up another 2.5 cm mass. I didn't bother having it biopsied I just said take them both off. The second mass was calcificatios. However, my other breast was full of atypical cells and calcifications so I am sure I made the right choice for me.

  • medinorth
    medinorth Member Posts: 67
    edited January 2011

    Thank you Valeriekd, misfit, cookiegal, and D4Hope for your responses

     Valeriekd - Since there is no difference, why do so many people opt for the mastectomy?

     misfit - Which chemo regimen did you have?

    cookiegal - Can you tell me the name of that recent article and study?

     D4Hope - I'm glad you made the right choice for you!

  • Omaz
    Omaz Member Posts: 5,497
    edited January 2011

    medinorth -  I chose lumpectomy/rads after the MRI showed a single tumor and the size ratio of the tumor to breast was favorable for lumpectomy/rads.  My doctors left the decision to me except for my rad onc who really through the lump/rads would work well.  Both my surgeon and med onc seemed very comfortable with lump/rads. More worry its true though, perhaps that is why some women choose mast.

    On the breast cancer watch website it says: Fear of breast cancer recurrence and the understandable impulse to avoid associated pre-event anxieties continues to be a powerful motivator behind the continued election of mastectomy and the underutilization of BCS (breast conseving surgery) to this day.

  • Fearless_One
    Fearless_One Member Posts: 3,300
    edited January 2011

    I had lumpectomy/rads and with I had the Mx.   It just was all happening so fast, but now that I have researched reconstruction options and seen ladies who look great after their surgery, I wish I had the mastecomy and will be getting one in March.   Because I have dense breasts, I worry it will come back and they won't see it.

  • Omaz
    Omaz Member Posts: 5,497
    edited January 2011
    Fearless-One - I have dense breast tissue as well, after reading your post I wondered if the density drops after menopause (or chemopause) and apparently it does. 
  • bcincolorado
    bcincolorado Member Posts: 5,758
    edited January 2011

    I have "stupid boobs" (dense tissue) too.  I started with lump in 9/09.  I personally wanted to do the least invasive thing possible.  Then I had no clean margins and has a "re-excision" in 11/09.  At that point without clean margins and 2 kinds of pre-cancer cells the BS said it had to go so I did the mx in 1/10. 

    For me the decision to start with lump was a pretty easy one.  Some women say "off when them both" and remove them both.  I chose not to, even after the surgeries.

    I know it is a hard decision but you have to do what will give you the most peace.  I'm still glad, even after 3 surgeries to get it out of me, that I started with the lump.

  • ruthbru
    ruthbru Member Posts: 57,235
    edited January 2011

    Lumpectomy, chemo, rads. I am very, very happy with my decision. So much less invasive and quicker to get back to my life. I don't know if I could stand to do all the additional sugeries, recoveries, time, pain and hassle that the recon ladies go through, but I also don't know if I could be OK with no boobs. Alot of people don't have the option, but I'm glad I did!

  • medinorth
    medinorth Member Posts: 67
    edited January 2011

    Thank you Omaz, Fearless_On, bcincolorado, and ruthbru for your responses

     Omaz - You didn't have chemo? Why do some have to have it and others don't?

     Fearless_On - Good luck!

    bcincolorado - It was an easy decision for me too.

    ruthbru - I'm waiting to get back to my life too! I feel like everything is on hold.

  • Claire_in_Seattle
    Claire_in_Seattle Member Posts: 4,570
    edited January 2011

    Medinorth..... Actually most women with early stage breast cancer have a lumpectomy.  I have seen the statistics and don't quite remember, but in the 70% range.  And for the reasons everyone mentions.  My own feeling was you can always remove more later, but I also believe less is more.

    So focus on healing and doing what is needed to extirpate the beast from the rest of your body.  At 7 months post radiation, I am doing 12 mile treks of arduous x-country skiing.  I am not sure I would be able to if I had both breasts removed.

    Understanding the rigors of surgery and recovery, my first words to my surgeon were "can I have a lumpectomy".  I was beyond thrilled when she said "yes". - Claire

  • ruthbru
    ruthbru Member Posts: 57,235
    edited January 2011

    The other thing is; whether or not a person would have a recurrence somewhere else in their body is already in the works long before one has either a lumpectomy (plus rads) or a mastectomy; either the cells have escaped to other parts of the body already or they haven't. That is why most Stage II people are recommended to have chemo (maybe the people who don't have chemo have no nodes involved, are Grade I (which is slow growing) and so strongly estrogen positive that they can skip right to anti-hormonals). ???

    Everyone who gets this diagnosis is in a panic mode and I don't think the medical establishment is very good about making sure their patients understand what the statistics really mean, and also everything that is involved, both mentally and physically, in losing a breast and going through what might be repeated surgeries for reconstruction. The more surgeries you have, the more money they make (very cynical of me, but true).

  • suemed8749
    suemed8749 Member Posts: 1,151
    edited January 2011

    hi medinorth - Glad you got clean margins and are done with surgery. When do you begin chemo? I did TCH x 6 and H for a year, and although I don't want to downplay the side effects, it was easier than I ever feared before I started. I worked throughout (took 4 days off during chemo week), took some road trips, and kept up with cardio workouts. There's a great TCH thread here that was my hangout during chemo - still keep in touch with some of the women I did chemo with. You're going to do fine.

    Sue

  • Omaz
    Omaz Member Posts: 5,497
    edited January 2011
    medinorth - Oh I definitely had chemo!  I was just speaking to the surgery part of treatment.  I had taxotere/carboplatin, am still on herceptin infusions until next August and after rads will start anti-hormone therapy. I also have a port until the hercepin is completed.
  • mdg
    mdg Member Posts: 3,571
    edited January 2011

    I am only Stage I but I decided on BLMX.  For me the information that made me turn this direction was:

    1. I was twice as likely to get BC in my good breast now that I had it in the other side

    2.  Though 10 year survival rates were the same for mastectomy vs. lumpectomy and rads, the recurrence rates were different.

    I am a mom of a 4 year old son and I don't ever want to hear "I am sorry, there are cancer cells" again.  I know I don't have that guarantee, but if I had done lumpectomy and rads and got the cancer back again, I would not be able to live with myself that I didn't do everything possible the first time around.  I know it can still come back after BLMX, but I guess if it does, I will know that I did everything I could and God must have a greater plan for me.  The other thing is that if it did come back again, I would get a MX anyway.  I just want the best chance of never having to deal with this again plain and simple. 

    It is very much a personal choice. I don't mean to push you my way at all by what I wrote.  I just wanted to explain what things really impacted my decision to be more aggressive.  In the end, the decision has to be YOURS and YOU have to be OK with it. 

  • medinorth
    medinorth Member Posts: 67
    edited January 2011

    Thank you Claire_In_Seattle, ruthbru, suemed8749, omaz, and mdg for your responses and well wishes

     Claire_In_Seattle - Your progress 7 months post is very encouraging.

     ruthbru - I understand that better now, thank you.

    suemed8749 - I start in two weeks.

    Omaz - What brand of port did you have?

    mdg - I had to look up mlbx! As a new poster, all of those acronyms are confusing. Is there is a guide somewhere on the forums for them? I don't feel pushed by you at all and I appreciate your perspective.

  • Omaz
    Omaz Member Posts: 5,497
    edited January 2011
    medinorth - I have a powerport.  Very low profile.  Before the placement I marked the estimated area so that it wouldn't be under my bra strap.  My surgeon likes it closer to the middle over the harder part of the chest so it is easier to access.  Mine is just outside the shirt opening area about 1.5-2 inches below my collarbone.  It took me a while to get used to it but now we are ~mostly~ ok together.
  • rachel5738
    rachel5738 Member Posts: 920
    edited January 2011

    medinorth---I had lumpectomy--I had a lump 1.7cm--Grade 1. I have bigger breasts so the lumpectomy--although makes one boob smaller isn't terribly noticeable. I'm comfortable with my decision. I had FEC-T X6 and will undergo 25+5 boosters along with Tamoxifen. As others had mentioned, it is a personal decision--you have to do what is right for you.

  • lago
    lago Member Posts: 17,186
    edited January 2011

    Just raising a hand for another with dense breasts. Oh and my mom (and sister) has them too. She's 73 and her doctor tell her she has the breasts of a 20 YO… she also had 3 kids so some women don't un-dense after menopause.

  • bdavis
    bdavis Member Posts: 6,201
    edited January 2011

    Hmmm jury is still out for me. I had a lumpectomy, 2 nodes removed, and will have TC x6, rads and Hormone therapy, but I will also have genetic testing. If the genetics come back positve, I will opt for BLMX. My doc thinks it will be neg... For me, my lumpectomy is totally unnoticeable... plus my ER/PR+ percentage was 98%, so my cancer was very driven by estrogen... so I am considering removing my ovaries... My one concern about leaving my breast intact is that I still have ADH (atypical ductal hyperplasia), so will the radiation eradicate those abnormal cells? Am I just waiting for them to become cancer? My surgeon and onc say not to worry about it and that the tamoxafen will take care of a lot of my issues... btw, my node involvement was a micromet, and tumor was 1.9cm... And also very dense tissue... I found my lump, not a mammogram. And I am 47 years old.

  • bevin
    bevin Member Posts: 1,902
    edited January 2011

    HI There, I am stage 2, no lymph node involvement , onco score 11, grade 3, and I chose a lumpectomy.  I am very happy with my choice and my surgeon shared that lumpectomy with radiation and hormone drugs is as effective as a masectomy.  For me, I have some other medical issues, am young (45) and didnt want extensive surgery.  It was the right choice for me and given I was treated at a major cancer center I feel confident with my choice .  I know how scary it is to feel comfortable with your selections for treatment.  I chose to skip chemo and have been uncomortable with that for a bit now.  My final treatment was lumpectomy, radiation (38 rounds) and hormone treatment. Good luck, I hope you come to peace with your decision.

    Bevin

  • PinkSurvivor
    PinkSurvivor Member Posts: 63
    edited January 2011

    I had no choice but to have a mastectomy of my left breast due to the size and location of the tumor.  I did however opt to have my right breast removed at the same time, the reason for this is because I didn't want the constent worry and wonder if the cancer had or would spread.  Being so young with no family history of breast cancer scared me.  So I opted for bilateral mastectomy with breast reconstruction, I was a DDD prior to surgery, so it is nice to be able  to go to a full C now and both breast will be symetrical.

  • Fearless_One
    Fearless_One Member Posts: 3,300
    edited January 2011

    Yeah, doctors will say how breasts get less dense with age, but mine are as dense now as they were 5 years ago at 40 and now I am 45 and in chemopause.   

  • Omaz
    Omaz Member Posts: 5,497
    edited January 2011
    Fear_less - Oh well, it was a nice though that something 'good' like less dense breast tissue would come of all these hot flashes.  When I was considering the mast vs lump the inability of the mammo to pick up the tumor was one of my concerns.  I don't know what tests will be used for follow-up.  I think there are some news ones out there that look promising.  I guess I will start learning about that after rads.
  • MaxineO
    MaxineO Member Posts: 555
    edited January 2011

    I am new here, diagnosed 12/1/10 and have yet to have my surgery so don't have full pathology. My surgeon is now considering lumpectomy vs. mastectomy, and I have a question, and I hope you all can provide input.  I will surely have chemo, radiation, and hormone treatment. If I have immediate reconstruction after mastectomy, does this impact the treatment? Also, are later mammograms/MRIs sensitive enough to 'read' the tissue remaining after a mastectomy?

    I know I am stage II with at least one node (where they originally found the bc).  Also, I have very dense breast tissue...they didn't see the breast lump on the original mammogram and had to do an MRI.

    Thanks all!

    M

    diagnosed 12/1/10, age 38, stage II, grade 1, ER+/PR+, HER2-, in at least one lymph node

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