Question for anyone with dirty margins after lumpectomy

Hi Chloe,

I'm so sorry that you got such a nasty surprise from your lumpectomy. My situation is similar in some respects to your situation - however, no one recommended managing the situation with radiation.

My breast surgeon performed an excisional biopsy (we didn't know yet what was in the breast other than, as others have described, the MRI was showing all kinds of weird stuff) and she aggressively went after clean margins by taking a 6x7 cm area of tissue.

The path came back saying grade 3 DCIS and that there were no margins at all. This might be a slightly different situation, I guess, than dirty margins - I'm not sure what the semantics are. However, the recommendation of my surgeon was a mastectomy. They aren't ruling out radiation later as an adjuvent therapy if the DCIS goes up to the chest wall, but the first step is to take out all the cancer, and I'm on board with that.

Maybe others who have had dirty margins + radiation can speak to their own experiences, but for what it's worth that is my situation. Hope you are able to figure out the approach that is best for you!

Hi Heart,

I was able to have a third lumpectomy to get that last margin, but it wasn't near the skin or the chest wall.  I don't really know how much DCIS was there, in total, because it was multifocal.  I'm thinking around 6 cm, but I put 5 cm in the signature, below, because just not sure (might just take it out).  The surgeon was not happy leaving that one margin after the second surgery.  She gave me a choice between another lx and mx, and I chose lx and ended up with wide margins.  I had standard rads.  There was a woman having rads at the same time as me, who had boosts to the area close to the chest, because there was a close margin right there, and they couldn't do a second surgery.  At my institution, they don't routinely do boosts, but she got it.  I had the standard protocol.  Maybe you want to get a second opinion before proceeding.

By the way, I love your description of the "shark-bitten look".  In my case, it actually did go away after the radiation.  I had swelling from the rads and the scar tissue from the three surgeries, and somehow it looks better post rads than it did post-surgeries and prior to the rads.  I had actually had three previous surgeries on that breast (so now six), and even though the breast is smaller, it's now back to kind of having regular contours (except when I raise my arm--then there's a big empty space--but no one sees that).  Anyway, if I were you, I'd get a plastic surgery consult and maybe another bs consult and then make a decision which way to go.  Maybe you can get an MRI to see if they find additional suspicious areas, before you make a final decision. About rads "cleaning it up" you have to go on faith with that.  There's no way of knowing that, just hoping for no recurrence.  That's why any of us get rads, because there can be stray/errant cells that did't show up anywhere, and the rads are supposed to zap them. Best of luck.  You are welcome to PM me if you have any other questions.