Positive margin, is there same situtation or any suggestions?

Jane, my situation was somewhat similar to yours.  I had a very large excisional biopsy (which is the same surgery as a lumpectomy and a partial mastectomy) because I had suspicious calcifications in two areas of my breast.  The pathology showed that both areas had high grade DCIS with comedonecrosis, and I had a microinvasion of invasive cancer. None of the margins - none on any side of either of the areas of cancer - were clear.  So there was no question that I had more DCIS in my breast, and my surgeon recommended a mastectomy.  I wasn't sure about that, and I also knew that if I had a mastectomy, I wanted immediate reconstruction, and that wasn't possible with my first surgeon.  So I went for a second opinion. The second surgeon confirmed that a mastectomy made the most sense, given all the dirty margins.  He also sent me for an MRI, which confirmed that my breast was full of "stuff", which he couldn't say for sure was all DCIS, but which we suspected was.   Between going for the second opinion, getting the MRI, having another biopsy on my other breast (benign, thankfully), consulting with a plastic surgeon and then waiting until there was a date when my breast surgeon and the plastic surgeon were both available to operate together, it took 2 1/2 months.  With an microinvasion already having been found, I knew that my DCIS was not just extensive and high grade, I knew that it was right on the verge of converting to become IDC.  So I was worried.  But my surgeon wasn't.  He was not concerned about the delay at all.  And in the end, he was right.  My mastectomy uncovered a lot more DCIS, but no more microinvasions, and the sentinel node biopsy on my lymph nodes came back clear.  There was no change in my diagnosis.   

With DCIS, waiting a couple of months usually is not a problem.  DCIS is not invasive, and therefore it cannot metastasize.  DCIS cancer cells can evolve to become invasive cancer but current scientific knowledge suggests that DCIS cells must undergo a molecular change that gives the cells the ability to break through the milk duct, survive in open breast tissue, and spread beyond the breast - and that's the point at which the cancer becomes invasive cancer and is no longer DCIS.  Most breast cancer takes years to develop, and for those who start with DCIS, it usually takes years for the DCIS to evolve to become IDC. Therefore it's extremely unlikely that anything is going to change within a couple of months.

It's normal to worry.  I remember being so worried too.  But I kept reminding myself that most experts say that a couple of month wait with DCIS is no problem, and in fact because I'd already had the excisional biopsy, my situation was better than most.  Having had the first surgery, it meant that most of my DCIS - and probably my most aggressive DCIS (which I figured was most likely to have shown up on my mammo) - was already removed. Since you've had the lumpectomy, your situation is the same.  Although you had a dirty margin, it doesn't mean that there is a lot of DCIS - or even any - left in your breast on the other side of that margin.  Your surgeon removed the most obvious area of DCIS based on what was seen on your diagnostic films; the dirty margins suggests that there might be some DCIS left, but maybe there isn't much at all.  Keep reminding yourself of that, and don't worry about waiting 2 months to get the immediate reconstruction that you want.  

Hope that helps! 

That's a long time to wait! You should have been having your surgery when you saw your doctor getting the path report.

Beesie, I think ma111 may have been saying that she thought it was a long time to wait before receiving the pathology reports.

Jane - That does seem like a long time to wait for the mastectomy.  I had my lumpectomy in March of 2010 and had positive margins and one positive node and had the mastectomy in April of 2010.  About 1 month after the first surgery.  I would talk with your doc and see why they want you to wait so long.  I also had immediate implant with the mastectomy.  Good luck and we are all here for you.

Jen

cycle-path, yes, maybe that's what ma11 meant.

I will make just one more comment on this, however.  We need to be careful to not compare treatment and timelines for those with DCIS to those who have more aggressive invasive cancers and nodal involvement.  It's not the same at all.  

Jane, your middle of the night nervousness is completely normal!  My advice is to talk to your doctors, explain your concerns, listen to their recommendations and make the decision that's right for you.  Don't let yourself make a decision that's driven by fear because the fear is not rational and in the end, the fear will go away but you will have to live with whatever decision you make.  So make the decision that reflects what you really want to do, based on the recommendations of your doctors.