Lumpectomy or Mastectomy

Make sure you discuss your reconstruction options with your breast surgeon and plastic surgeon.  If you have a lumpectomy and radiation, reconstruction is difficult.  Good luck with your decision.

I'm in the same boat...and our circumstances are similar...I'm older, 46, was diagnosed this past November. They did an MRI that showed 2 enlarged mynph nodes, so I had a lymph node biopsy that showed they were positive for cancer cells. For that reason, they had me do chemo first. Had ultra sound last week that shows very good results. Tumor is gone! Anyway, I am about to get surgery and have been having the same debate. I was also going to recommend the genetic testing. I had it done and should have results Monday. That will help decide for sure. But, even if it is negative, I am leaning toward double mx with recon...because I have small breasts, dense breasts and fear the amount of tissue removed would be significant, plus radiation would be recon very difficult if I needed to do that later. I really don;t want to go through the mx and recon, but it may be the better of the two choices for me. Good luck with your choice. When do you have surgery? Mine is scheduled for the 21st.

Hey djay,

My situation is very similar to yours. I was diagnosed at age 33 on December 5th, 2011 with stage 3 TN breast cancer. My tumour was 3.5 cm with possible lymph node involvement, but they weren't able to tell for sure as I am having chemo first. I am currently halfway done chemo, then BMX with reconstruction, then radiation.

I briefly met with my surgeon and she recommended having both breasts removed and I agreed. I realize that it can come back somewhere else in my body or even in the small amount of remaining tissue, but I will feel much better having both removed. It will reduce my worry and will also make reconstruction easier. My surgeon also told me that having cancer in one breast ups your risk to have cancer in the other breast if it is not removed. Due to my young age, I feel that having both removed is best for me.

Hope this helps! Feel free to message me if you have other questions or just want to talk.

My advice would be to talk to your surgeon about whether the margin can be improved - either with a re-excision or a MX. I had a very close 1 mm margin too, but it was almost at the chest wall, and even a Mx wouldn't have made a difference.

Surgeons (actually all of us) are less concerned with stuff happening in the breast than distant recurrence ... because as my surgeon said: No one dies of cancer in the breast. True. The question is, whether or not a Mx or a BMX would reduce your risk...

Has your onc said anything about additional chemo? Sometimes that's an option when there hasn't been a complete pCR in the neoadjuvent setting. However, many of us have surgery first, then chemo, and have no way of knowing whether the chemo "got" it all or not - and that's the end of our treatment anyway. So no right or wrong here.

I know what's it like to research something to death - at some point, line up your questions, and go talk to your docs and see what they say. At the end of the day, you have to feel comfortable with whatever you decide.  

Just a few thoughts.

One - can you have chemo before surgery?  Then, you will be able to tell whether your tumor responded to the chemotherapy.  This is becoming more and more common - chemo first - surgery second.

Two - flat's pretty awesome....  Reconstruction is an option... but so is going and staying flat.

I understand what you're saying about the double... but htink of it as much much less breat tissue that can "go wrong" - so to speak... Does that help?

 My story - TNBC diagnosis July... August chemo... Feb double mastectomy... No regrets on the surgery choice....  Happily - complete pathological response.  I was also in a clinical trial called ISPY2.

Good luck - this is a difficult time, and I wish you peace around whatever decision you make.

Lee

Djay: Unfortunately mets can occur without detection of lymph node involvement. However, an abnormality on a bone scan can be many, many other things, so please try not to worry until you have more information. 

tallguysmom, there is an article on the main Breastcancer.org site called Mastectomy vs. Lumpectomy that goes through the reasons for choosing one or the other. Until more members post with their experiences, that might be a good place to help organize your options.

The Mods

I leaned toward a BMX from day 1.  I was 33 years old and wanted to do the most aggressive things possible to beat this.  After talking to my surgeon, the most important thing for my peace of mind was removing that lump and I had surgery 4 days after getting my dx. 

I decided to start with a lumpectomy knowing that I could always go back and have more surgery.  The lumpectomy was successful - smallish lump, good margins, negative lymph nodes.  I started chemo and about halfway through, decided that the BMX felt right to me.  Everyone who examined my breasts couldn't believe I found my own lump because of how dense my breasts were.  That made me scared that if it were to come back on the other side, I might not get lucky enough to catch it early again.  Personally, I just couldn't handle the worry that went along with that possibility.  6 weeks after completing chemo, I went in and had a nipple and skin sparing BMX with lat flap reconstruction.  I'm 7 weeks out from that now and even though I've had some bumps in the road with my recovery, I don't regret the BMX for a second.  It's given me more peace of mind than I had otherwise. 

Statistically, my outcome was likely to be the same regardless of what choice I made, but for my own personal comfort, the BMX was right for me.  I think everyone has to weigh their options and know what will make them feel best.  It's a crappy decision to have to make, but I think that once you do, you'll feel good about it because you'll have your plan in place and you'll feel in control. 

I was BRCA -, no family history.

Kane, sorry you have to do this crap all over again. If you don't mind sharing, why did your first BS recommend a Mx? He/she didn't say a BMx, right?