Lumpectomy or Mastectomy - NEWLY DIAGNOSED & CONFUSED

I'm surprised that they staged your tumor before surgery. They don't know its actual size, and they don't know if it's in the lymph nodes. Information about both will affect stage.

Stage I and Stage II sisters typically get the OncotypeDX test done to determine if classic chemotherapy will be helpful, or if the risks outweigh the benefits. The OncotypeDX also tells each of us our risk for distant metastasis.

You might want to read Judy C. Kneece's book, Breast Cancer Treatment Handbook. It provides a lot of basic information that will help orient you.

Kneece's book was given to me by the group who diagnosed my cancer. When you have a chance, tell the group who diagnosed you to provide this book to their patients, too. It does wonders to have the information you need when you need it!

I was surprised by the stage because I wasn't staged based on the biopsy report. But, I've just read in the NCCN Guidelines for Patients that it's not uncommon. So, it was just my lack of information.

Glad you are getting the OncotypeDX and BRCA test as well. You will have a lot of information to base your decisions on.

Here is the link for Guidelines for Patients by the National Comprehensive Cancer Network (NCCN): www.nccn.com/cancer-guidelines.html. 107 pages but it's well organized and clear writing. Several of your questions are answered in this booklet.

It is also possible to read the guidelines for physicians if you register. 

I am awaiting surgery on June 18th, and was also told staging would be done once they remove the tumors.  I have what appears to be two tumors in my right breast (possibly one larger one since they are close together).  Grade 2. Like, you, I wanted to have as much information at my disposal before making the surgery call. 

I was in the same boat you are just a few short weeks ago.  I was diagnosed on May 11th.  I'm only 40 and have 2 young children at home.  My BS said lumpectomy was an option, but I am only an A cup, and my right breast is already smaller.  I immediately had the genetic testing done, which came back negative, thankfully.  My BS did say that had that been positive, she would strongly have encouraged a BMX since your odds of recurrence are so much higher if you are BRCA positive. 

One great decision I made was to meet with my MO *before* surgery.  I had originally been told that you typically don't meet with your MO until afterwards, but that consulation was the best one I could have had.  I was also trying to decide between lumpectomy and mastectomy.  Lumpectomy seems the less invasive route, but radiation is no walk in the park and could affect your reconstruction options.  Due to my age and the multifocal nature of my cancer, my MO strongly suspects that I will need chemo.  I'm glad I knew this before surgery as well.  I also asked my MO about the Oncotype test, and she said that would definitely be something we do after surgery.

I also didn't want to be worried about recurrence.  I also met with two PSs.  I didn't care for the bedside manner of the first, but I loved the second.  I'm so happy that I trusted my instinct on that one.  In the end, I decided on a nipple & skin sparing BMX with immediate reconstruction to Sientra TEs.  Even though my PS thoroughly reviewed each reconstruction option with me, I am quite thin, and the implant route was best suited for my build.  However, he did say that should I end up needing radiation, he would suggest we go with the Latissimus dorsi flap *after* radiation is completed because radiation can cause the tissue & implant to become hard.

I read a lot of information, and I agonized over this decision.  It's not easy.  But I'm trying to make the best of it, and hey, I'll have some nice, larger, foobs that are cancer-free once all is said and done.  You're not alone and don't feel rushed to make a decision.  Ask as many questions as you need to in order to feel comfortable with your decision.  Did you have a breast MRI?  

Hang in there. Hugs.

Hi, juneaubugg - that's a tough question, and every answer is right - for someone.

Here is how I made my decision:

I was a dx with both DCIS and IDC in the left breast. The Breast Surgeon offered a lumpectomy with rads but because the cancer was multifocal, she felt I wouldn't be satisfied with the results (she'd have to take a huge wedge of tissue out), and that a UMX would be better.

Well, I was a 38DD/38DDD, and there was no way they could match the girls up even with a reduction on the right (which I had always wanted) so the decision for a BMX was easy.

That, plus the fact that with my history (Mom had BC) and that I had very dense breast tissue making it difficult to diagnose the right side, made me feel very comfortable with my BMX decision. Turns out that no cancer was found in the final path report on the right, but I'm convinced (as was my Radiologist) that it was just a matter of time.

I am six months out from surgery, I've healed really well, and I'm done with my fills. I got TEs in preparation for saline implants in September. I postponed the exchange surgery so I could lose a signficant amount of weight first.

I was fortunate. All my margins were clear, and there was no cancer on the chest wall, or any lymph node involvement. But we didn't know that until after the BMX - when the final pathology report came in! I did not need chemo or radiation. I will, though, have to take Arimidex for five years starting in the fall for my ER+ status.

I didn't want the extra recuperation time of any of the flap surgeries, and I didn't mind having the TEs in. I'm 61, and have had droopy, heavy, big breasts my whole life. I was ready for perky. If I have a problem with the implants in 10 or 20 years, well, I'll be 81 and I'll deal with it then!

Other ladies have gone for the flap procedures and have had wonderful outcomes. They are very happy with the choices they made. There are also good reports here about fat grafting.

Some of my friends have had multiple lumpectomies, and finally made the decision for mastectomy. Others have had one lumpectomy years ago and have had no evidence of cancer since then.

I know I had the major surgery for a relatively small cancer, but I have absolutely no regrets. (But I will be much happier after my exchange, when I cross over to the Squishie Side.)

Wishing you the best  - please let us know what the docs have to say!

PS:  My biggest regret would be if I take the easy way out - less drastic solution - and have to deal with this all over again, and in a worse way.  I guess, the better informed the best decision you can make.

It is your life, you choose what is best for you!  That is my goal!

Hi

I'm 4 years out from dx but had the same dilemma as you all. When I asked the surgeon what he would recommend if it was his wife, he said 'lumpectomy........ if it comes back it's another lump. If it's a mastectomy and it comes back, it's on the chest wall'. That decided me.

OK the WLE has left me with a mangled boob, but it honestly doesn't bother me. When I'm dressed no-one would know.

Good luck in your decisions. 

I had a bmx.  It was a tough decision, but several factors helped.  One factor was that I had dense breast tissue on the sides of both of my breast.  This tissue was so large that once removed it would have left me very deformed.  The bs also would not proceed without biopsying the other side in addition to the side that had the cancer. Anyway, knowing I had invasive and ductal cancer and this other info, my husband and I decided to make the decision.  I chose to have all removed and just have reconstruction. It gave me peace of mind and I knew this decision might prevent the need of radiation. I also was not staged until after the bmx.  I was told the lymph nodes play a major role in this process.  Thankfully, I had no lymph node involvement. I will have my exchange surgery in two weeks and I have regained my strength.  I have no regrets!