do surgical margins need to be clear?

If radiation were that effective when used in the manner you're suggesting, why wouldn't they have done it to begin with, instead of any surgery at all?

I don't know the answer that that question, I'm just asking it... hope someone does have the answer, because it seems like it would be important to know before you make a decision.

sockarmom, why is your husband suggesting that you not go back for the re-excision surgery?  Is your husband a breast cancer surgeon?    

Here's what it means when you don't have clear margins. The breast tissue that was removed from your breast was analysed under a microscope. In one area, the pathologist found cancer cells right at the edge of the tissue.  Logically, it's reasonable to assume that if there are cancer cells right at the edge of the tissue that was removed, there will also be cancer cells in the breast tissue on the other side of that edge, i.e. the side that's still in the breast. What nobody knows however is how many cancer cells are left on the other side of the cut line, or how large the remaining area of cancer might be. 

If the cut made into the breast tissue was right where the area of cancer ended, there might only be a few cancer cells left in the breast beyond that cut line, and in that case, radiation might be effective.  But what if the cancer continues in the breast beyond that edge for another 5mm, or a 1cm, or even more than that? Screening is not precise, so while the surgeon would have estimated the size of the area of cancer based on the imaging from the mammogram (and ultrasound and MRI, whichever you had), it's possible that the area of cancer was larger than what showed on the images. So without further surgery, there is no way to know how much cancer is still in the breast. The only thing you know from the 'dirty margin' is that in all likelihood there is still some cancer left in the breast.  

That's why a re-excision surgery is necessary when the margins aren't clean. 

Since sockarmom had an SNB done with her lumpectomy, I've assumed that her diagnosis probably is invasive cancer, not DCIS. I might be wrong about that, but usually an SNB isn't done with a lumpectomy for DCIS. The presence of a microinvasion on the other side of that dirty margin would only be relevant if the diagnosis up to this point is DCIS and not invasive cancer, but even at that, a microinvasion alone probably wouldn't change much about the treatment plan vs. pure DCIS. I had a microinvasion and it made no difference to my treatment, except for the requirement that I have the SNB (which sockarmom has already had).

sockarmom, have you made a decision about the re-excision?  And to the point that Lolalee raises, what is the pathology of your cancer and the pathology of what was found in the margin? 

You need to have the clear margins.  Radiation is sometimes used even when the margins are clear, but close.  Mine were 1mm and 3mm from chest wall and skin, so even though they were technically "clear,"  I still had to do radiation.  I had mastectomy and just didn't have anything left for reexcision, so that's why they couldn't just go back in. 

Clear margins are essential.

Having surgery again on Monday to get a larger margin. One of them was <1 mm so back I go. Clear margins are essential to start rads. Mine were clear and most were over a centimeter but one of them was too close. A small price to pay imho.

I had BMX with DIEP on 3/4/13 for bilateral invasive ductal CA. I was just told that the upper margin near the tumor in the left breast showed a cluster of microscopic cancer cells near the edge. My BS says this has only happened to her 2 times previously, and that it is a fine line taking enough tissue to eradicate the cancer while leaving enough under the skin for the PS to get a good cosmetic result.

Also, I discussed with her that I had read that this can be a result of how the pathologist prepares the specimen, slides, etc and she agreed with that. But, stated that we cannot take a chance and just do nothing based on speculation that this report may not be accurate.

She says radiation is out due to the DIEP recon, and although she did not recommend it, one option is to just take the oral drug and watch this area. No thank you. We both feel that going back in to re-excise this area is essential, so back I go to surgery within the next two weeks.

It sucks, but clean margins are important to make sure I've done everything I can to prevent a recurrence.

Hi granwe, I am so sorry to hear you will need further surgery.  This did not happen to me but I am sure that once they have removed further tissue they will have a better idea what they are dealing with.  

I would assume that radiotherapy will be recommended along with chemo.  Hopefully someone who has experienced this situation will reply to you soon, meanwhile know that I am thinking of you and send best wishes for a good outcome.

Hugs Lola.

V1Teach - Let's hope that third time is a charm, right? You must be sick of the way this is dragging out.

In the meantime, you may find additional support on the lumpectomy thread ("Lumpectomy Lounge") and, if you know your stage, there is a group for each stage that you'll find very welcoming.

paisley-for every 1 re-excision that comes back without clear margins, there are about 10 that come back clear. However, when they come back not clear that second time, an mri is a very good idea. What’s likely happening is there is another area that mammo & ultrasound did not detect and it can’t be seen with the naked eye. MRI should pick it up and give the surgeon a better view of where they need to excise. You can also request mri after the first margin comes back not clear before going back in.

I am scheduled to have a re-incision this upcoming week, as my margins were not clear with the first lumpectomy. Concerned about not having clear margins as well. It was recommended that I don't need chemo as my oncotype score was low. But this past weekend the opposite side of breast looked a bit red and sore. The incision site looks normal on the skin. It's been 7 weeks since the last surgery. Should I be concerned that it can be an infection this late in or something else?? Has anyone else experienced this not having clear margins before second surgery?