disfiguring lumpectomy vs mastectomy

Hi Tarry

I was almost at the point of having a bilateral mastectomy with reconstruction, trying to convince myself this was the right thing, then got the results of sentinel node biopsy - clear nodes.  I then went against the recommendations of doctors and had 2 WLE's - one side is a bit lumpy, but I still have them. 

I personally freaked at the thought, the word 'mutilation' kept going through my head.  I always thought BC was not the worst - 'you could always live without them' I thought, but when push came to shove that wasn't what I felt. 

I'm a public health researcher, and started doing lots of reading and decided I knew enough to risk it.  I also had the Oncotype DX test which has just come back 'low recurrence risk' so feel a , bit better. 

Its a tough call, just hope you can make the decision you can live with.

S

I was at 4 cm too and had a lumpectomy. I was pretty loped sided at first, but after awhile the fat moves around (and I mean awhile, up to a year), and now I look fine even in bathing suits (no, I could not be a topless model, but that was not a priority anyway). I, like you, did not want to have any more invasive procedures than I absolutely had to have. (I did have radiation and did not find it bad at all). With your feelings, I would do the lumpectomy. If you hate it, you could have more surgery later. This is probably bad to say, but sometimes I think doctors push women toward MX because they make a lot more MONEY if you go that route.

Tarry:  I would request that a breast surgeon work in conjunction with a plastic surgeon, to ensure that the lumpectomy defect is addressed by the two disciplines. 

One possibility would be a very small saline implant to augment the breast after lumpectomy.  Lumpectomy defects can also be addressed with fat graft transfer, which is actually a minimally invasive surgery.  This entails liposuctioning some fat - most often from the belly region - and filling that defect with your own fat and rich stem cells.  Another option would be using your own tissue - as in a flap procedure - to correct any lumpectomy defect.  But before we even go there, I think you need another opinion - with a plastic surgeon.  Take your records and let a plastic surgeon tell you how he or she he might mitigate your concerns about correcting any lumpectomy defects.  Try to get an appointment with Aldona Spiegel, MD in Houston.

http://www.breastrestoration.org/dr_spiegel.php

I would see a female PS.  Someone who can identify more with your intimate concerns about preserving your breast.

Deborah

As someone who started with lump (and still needed mx later) I can tell you that mx is disfiguring too.  If you are very anti mx, then you should do the lump.  There are things a PS can do to help make things not be so disfiguring after you are finished with treatment.

Tarry - Glad my words were reassuring and I'm happy to answer your other questions. After two surgeries in the same month (the partial mastectomy/lumpectomy and then two weeks later I was back under general for a sentinel node biopsy which odds are you will not need if you only have a lumpectomy; I was unfortunate enough to have a little surprise of idc show up in the final path. report, again this is most likely not going to be your case) and six weeks of rad. zaps, the idea of undergoing reconstruction seemed unimportant and I've never thought of it again. As ruthbru so well stated, things move around, and I don't do anything to fill in my bra. Rads were also not nearly as bad as I'd mentally expected, and I'm glad I zapped the $%^& out of any possible little stray bad cell. I am so fine with how I look -- in fact I love every single inch of what I have because it is all me, real and there, the nerves and feelings are still there and I appreciate that not everyone is so fortunate.  

As far as tamoxifen, I was fortunate that the rad.onc. didn't give me a hard sell or scare tactics. She just laid out the statistics for my personal condition, which was to take 1600+pills to lower my risk of recurrence from something like 5% to 2.5%. Again, these are personal decisions, I have the prescription and if I change my mind or something else changes, then who knows. I like the idea of not worrying that every little "thing" I feel is because of tamoxifen -- that would cause me more worry -- and as we know, tamoxifen potentially brings its own set of issues and additional monitoring requirements. Most people that take it find comfort in doing "all that they can" but just like I knew that the right decision for me was to keep the breast rather than have a mx or bmx, I looked in my heart and just found inner peace with my decision to opt out. Quality of life is not to be thrown out in the midst of the terror we all fear during this horrible roller coaster.

I had 2 tumours one 2cm and the other one 1.5 cm with about 1.5cm gap between them and I had a lumpectomy. I only have small breasts (b cup) and was 40 when I was dx and my BS talked to me about the  cosmetic effect before surgery and thought I would get an acceptable cosmetic result. While I do have a size able divert where the tissue was removed and my nipple now points to the left, when I wear a bra or swimsuit you can't tell and I still have a nipple and full sensation, I like having my own breasts and pleased I only had a lumpectomy and not a mastectomy.

I was diagnosed with DCIS (right) in 2008 (age 57), had a lumpectomy without clear margins and a re-excision followed by radiation.  The DCIS was more extensive than expected.  I also had a biopsy on the left side, which showed atypical ductal hyperplasia.  I took Tamoxifen for 2 mos with very serious side effects so had to stop.  In July 2011, I was diagnosed with DCIS on the left side.  After prayer and research, I chose to have a bilateral mastectomy with DIEP reconstruction.  I knew if I chose a lumpectomy and was diagnosed in the future with another BC, I wouldn't have a choice - there wouldn't be an option for another lumpectomy with radiation - I would have to have a mast.  Because of the radiation in 2008, I was not able to have an implant on that side......so chose the DIEP for both sides.  I'm 8 weeks out of surgery, and the healing has gone very well.  There's quite a bit of discomfort still, but I know, in time, it'll subside.  I have no regrets making the choice to have the double......but I also know reconstruction made that decision much easier!!  

 This is a very personal decision......one thing I've learned through this journey -- we can't judge the decisions others make -- were all different, with different needs, situations, etc.....and as long as we can ultimately "live with the decision", it's the right decision!!!  Do your research, Tarry, and read this community forum -- there's much to be gained!!