disfiguring lumpectomy vs mastectomy
I'm going to MD Anderson; I've seen the primary surgeon, but not the plastic surgeon. The first one said that since the involved site, with two foci, covers about 4-5 cm., a lumpectomy would be very disfiguring and would not leave me with a satisfactory breast.
I have since discovered I have a very visceral, negative reaction to having a mastectomy. I think I'd much rather have a disfigured breast than a mastectomy. I do suffer from an anxiety reaction, and I am getting worried here.
Is there something I am missing? I certainly respect the many reasons that lead women to choose a mastectomy, but my mind can't get around it. The idea of removing a breast entirely rather than having a disfigured one is not appealing to me at all in the least,, especially if I can have reconstruction in either case.
I'd love to hear from anyone with any insight into such a decision.
Comments
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Terry - I typically post on the dcis board, but saw your post's title on the home page and am glad that I did, because I felt and still feel EXACTLY the same way. I was given the option of a sizable lumpectomy (partial mastectomy) + radiation or mastectomy. I met with a wonderful plastic surgeon while in the decision-making phase and realized that in my heart I truly wanted to save the breast -- even with adding on having to do rads. Some people find comfort in just removing the whole thing, but I just couldn't get away from it feeling like an amputation.
These are such personal and individual decisions, and I wish you good inner peace with whatever decision(s) you make. As for me, I love my breasts -- both of them -- they reflect the real and natural me and what I've been through.
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CTMOM, your words are very reassuring.
Did you have any reconstruction? If not, do you do anything to fill out your bra?
I'm interested in your declining tamox. I'm nearly 70 and I am not at all happy at the idea of reducing the quality of life at this stage.
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I had no choice but to have a mastectomy. I wasn't happy about it and I pushed for lumpectomy, but there was way too much cancer.
Mastectomy can cause issues that nobody ever seems to talk about. Chronic pain and itching, shoulder problems, permanent numbness etc. I have had chronic problems for 2 years.
I highly recommend that women who are not going to freak out over cancer coming back get a lumpectomy to reduce some of these problems. A breast is not just a lump of flesh, it is a body part, and when you remove a body part, there are consequences.
It's an individual decision and to each their own but I do think people should be aware that all is not always well after mastectomy - and in fact, it often isn't. Complications are not rare at all.
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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
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CoolBreeze, I am so sorry you didn't have the choice.
Your words are giving me courage. I am nearly 70, but I'm very active in a full time job. Quality of life is very important right now; I don't have to try to be alive for 20 years to see my children into adult hood. I just have a short space of time to enjoy what has become a good life.
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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.
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Tarry - I also had a lumpectomy and I had a 4CM IDC tumor. I had chemo first to shrink my tumor. However, DCIS is different from what I understand - your 4CM encompasses the area of DCIS so chemo won't work?
In any case, even though I had chemo to shrink my tumor so that my breast would not be disfigured, my PS still took out a wide margin of tissue - the original 4 CM plus clear margins. It is the way he sewed it up to where I don't even have a divet. He did say a lot of it depends on where the tumor is located within your breast. Mine was on the left hand side close to my armpit area. I was shocked that he took out so much tissue but if you look at me and didn't see a scar then you would never even know.
Whatever you choose - this is your decision and that is what you always need to remember. Nobody can tell you what course of action you should take - to me it is the action that feels most comfortable to you.
I didn't want a masectomy anymore than I wanted to do chemo but I figured chemo was the better option for me personally.
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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
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Tarry-
Stick to your guns! I had a very well respected FEMALE breast surgeon that told me that a lumpectomy would be so disfiguring that she would need to do a mastectomy (I had dcis in 3 small areas). I went along with her and nearly 7 years later, it is the biggest regret of my life. In hindsight, I would have rather have had NO surgery than this. I always felt like it was an amputation (it was!) and while I am no longer in the pit of despair, I have struggled with depression ever since the diagnosis. No freakin way would I let them talk me into this again!
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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.
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Yeah, it's funny that somebody would think a mastectomy is less disfiguring than a lumpectomy. Even with recon, you are hardly going to look normal again.
I think at 70, quality of life is very important. You can always cut out more but you can't put back what you've taken. So, do it your way.
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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.
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I went for the mastectomy. I had both IDC & DCIS . The thought of having mamograms in the future on what was left of my breast really bothered me. Mamograms always bothered me, probably more than most women. And they missed my tumor(s). A lumpectomy would have a shorter recovery time. I had a BMX for bilateral tumors. One of my tumors was thought to have been a canidate for a lumpectomy, the other would have left me too "disfigured". I was(am) 52 & the BMX was doable(I hate that word-sounds like a home improvement project). I never really considered recon.
I also ended up having/needing RADs despite the BMX with clear margins.
I also never liked my breasts. They hurt a lot, got in the way, etc..... They work for breastfeeding but that's all I can say that was good about them. I also don't feel or consider myself "disfigured". As far as age, at 30 I probably would have had recon, at 50- no way!, at 70......Ok, I don't really know. I"think" I'd have a lumpectomy , oh but the mamograms, uugh! The BMX (with no complications) was harder than I imagined.
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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.
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LouLou,
That sounds similar to me. I'd be happy with your results, too. -
Coralitz, i'd be thinking very differently about reconstruction if I lost both boobs. Being lopsided is beyond me.
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You can always start with the lumpectomy and see where it leads you. I too thought it strange to focus on the disfiguring aspect of a lumpectomy when breast removal is such a major operation and is of course disfiguring itself, with or without reconstruction. I think sometimes they say that because they don't want to scare you by saying 'there is so much cancer there we want to take your breast'. But I could be mistaken. In my situation, I had a lumpectomy, that was supposed to be a simple procedure, two additional re-excisions and still no clear margins. After my breast was taken, much more cancer was found. It turns out that lumpectomy never would have been an option. But I felt and feel good that my surgeon tried to save my breast. I truly believe he did. It is helpful to know that as I go through reconstruction, which has not been particularly pleasant. Bless you as you go through these decisions. I think sometimes that is the hardest part.
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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!!
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