Decisions about surgery??

We have a similar diagnosis. I was 45 at diagnosis...no family history, exercise regularly, no smoking,etc....  I had a SNB first but was pretty sure I was going to have a BMX. When my surgeon did the SNB he saw the tumor there and just took it out.  I got the pathology back before my surgery for BMX.  I did do the BMX with TE's.  I got 2 opinions from PS's and BS's before my BMX.  I selected the surgeon I felt most comfortable with. My oncotype was 17.  I had LVI in my pathology of the tumor. After I got the final pathology back from the BMX there was some DCIS and another tiny invasive area.  I am glad things worked out that way with lumpectomy and BMX.  I so suggest meeting with the PS's to see what kind of reconstruction they recommend.  I was not a candidate for DIEP because I did not have enough body fat so implants were my only option.  SInce I exercise so much and teach aerobics neither surgeon would do any reconstruction involving muscle.   I hope this helps.

(((jsrose14)))...this is a very difficult time for you, I know what you are going thru, it's so hard to make decisions and not second guess yourself...my breast surgeon did a lumpectomy first followed by BRAC testing, MRI and PET scan so we had as much information as possible to decide whether to do a Bilateral mastectomy. I was glad we were able to get the lump out and do the axillary node dissection quickly after the biopsy so I had the time to complete chemo while I met with plastic surgeons and discussed my next steps. I had already decided that I did not want radiation due to the side effects and I am concerned about recurrence or a new occurrence in the contralateral breast, which radiation to the tumor bed after lumpectomy would not prevent so in light of my risk factors and the fact that I want reconstruction I decided to schedule the bilateral mastectomy. The plastic surgeons have been very clear - if I have radiation they may not be able to do implants and, like you, I don't have enough of my own tissue to do a DIEP. My surgery isn't until March 4th so I can't tell you how that surgery went but I think I am making the best decision and my team supports it (oncology, plastic surgeon, breast surgeon and internist) so....like others on these boards have told me - make the decisions you need to based on the information you have and don't look back...Good luck with your decisions...(((hugs))) Maureen

My situation was very similar to doxie's.  I had lumpectomy + radiation because nothing more drastic was indicated.  Although I have dense breast tissue, my risk of developing ipsilateral (same breast) or contralateral (oppositive breast) is fairly low going forward because of the treatment protocol that I had.

The issue between to have a mastectomy or a lumpectomy is not one of long-term survival.  Both types of surgery have the same survival outcomes because the surgery itself does not affect your risk of developing metastatic disease in the future.  Your risk of developing metastatic disease is determined on the stage/grade/hormone/node status of your cancer - and your genetic predisposition towards developing metastatic disease - not on the type of surgery you choose.  That's one of the reasons why some oncologists don't recommend a mastectomy when a lumpectomy will do the job.

That said, opting to have a mastectomy when it's not clinically warranted is a deeply personal decision that must take into account not only the nature of your cancer, but - also - your physical condition and emotional health.  A mastectomy is not an easy surgery; neither is the reconstruction process, if that's what you decide to do.  It has more risks and a longer recovery time than a lumpectomy.  A bilateral mastectomy is, even, harder.  However, if you are physically up to it and, emotionally, you know that you will just be too anxious moving forward if you don't have a mastectomy, then a mastectomy would be better for you.  You have to be able to move forward with your life without being terrified every time you have to go for a check-up or mammogram or dealing with unrelenting anxiety in between check-ups.

Amen re breast density. My case is not exactly like your, but I had a ductal excision aka partial mx aka lumpectomy that revealed ALH and ADH . I had a preventive mx three mos later which reveal a 1.1 cm Idc hiding in those dense breasts. The first surgery was not a big deal for me and I felt fine soon after. The second was tougher. The surprise dx was devastating.



I had mx to expanders to implants. It was tough but worth it to me. I'm thrilled with the new me. It doesn't feel the same but I'm glad the old ones are gone.