positive margin with implant

ginger2345 · September 2013

I'm one year out and still bothered by my pathology. I had tumor both IDC and DCIS at the anterior margin and when I asked my breast surgeon about it, she seemed happy that that margin was in the lab and not in me.

Now I'm going back to see the plastic surgeon about what might be done about the divot I have, and if it's something that requires general anesthesia I'm wondering about going for a clear margin. That could change even the size of implant that I'd need. Because I have the implant, there'd be no thought to radiating the margin.

It's distasteful to have to deal with things a year later. Just thought I'd see if anyone else had a dirty margin that supposed to be in the lab. I guess there's really no way to know if anything is left in the breast. My IDC comes out of DCIS which is likely to skip around anyway.

MNSusan · September 2013

Ginger, I'm kind of in the same boat. I had both DCIS and IDC and my deep margins were 0.5mm and 0.25mm. There are a lot of docs that would call that dirty margins. My MO says she's happy with a margin of even one cell and didn't recommend rads. When I talked to my BS about it, she said she really cleaned me out and didn't think anything would be gained by going back in. My PS said that if she saw anything at exchange, she'd take it out and send it to the path lab. She didn't see anything then.

I like all of my docs and trust their judgment. I think its normal to second guess to some extent, but I've tried really hard to stop. I guess there's nothing to be done now and I will just stay vigilant going forward.

I'll be interested to hear what your PS says.

ginger2345 · September 2013

Don't see the PS until Oct. 2. I'm going to look more carefully at my path as I dont' recall having as much info as you do. I'm afraid I do worry because my MO was concerned but dropped the topic when I said the BS said the tissue was in the lab and she got as close to the skin as she could. The trouble with reexcision is you don't have any guarantee of clean margins and then rads are suggested. But with the implant, that hasn't been discussed. And I don't want to put cosmetics before safety.

Really hate to be at this point nearly a year out. But feel I must ask the question now as the PS may have a way to improve my cosmetics so I'm in the discussion of a surgery anyway.

I guess not many others have this problem since no other postings. But I'm sooo glad you posted and I'll let you know what I find out. Thanks.

ginger2345 · October 2013

The plastic surgeon will do liposuction to fix my divot. Might take a couple of tries in his office suite so not a real big deal, certainly not the surgery I thought would open up the possibility to go for clear margins. The pathologist said they don't quantify how much tumor in the margins, so no help there. I could go back and talk to the surgeon and see why she was so sure the tumor was in the path lab. And I wonder if I'd be ready to go thru that again anyway. It's hard to trust and I guess we never know for sure.

The other thing is my tumor started out as DCIS and that is notorious for skipping around. I think there are probably many of us who get what we think is a clear margin, but it's just skipped over to another area. Probably my case with the cancer coming back. Once a cancer patient, that mindset is with us. And like you said, vigilance and doing the right things exercise and diet wise are important.

MNSusan · October 2013

Ginger, do you have a copy of your path report? It should say how close your margins were. My path report told me the exact distance. I've found that different oncologists see them differently. My oncologist said I was okay with a margin of even one cell, but there are other oncologists that would call that "dirty" and want to go back in for more. Maybe if you have a number (distance), instead of "it's in the lab," you'll feel better?

ginger2345 · October 2013

I have my path report but unfortunately I have tumor IN the margin that's supposed to be in the lab. We asked the pathologist how much in the margin, but he said they don't quantify it. It is all about feeling some peace of mind. I know that being the anterior margin is superior and not as unmonitored as other margins. Neither the surgeon nor the oncologist got too excited about it. My surgeon didn't use the words "cleaned me out" but did say additionally she got as close to the remaining skin as she could. I've got quite a thin layer of skin midline of the implant to prove that statement. My PS is going to do some fat grafting to improve that spot. Thanks for your response.

We were taking a National Park vacation tomorrow--bummer. Looking for plan b. So might ask my PS a question or two also but it's scheduled out since I was supposed to be out of town.

MNSusan · October 2013

We were supposed to drive the Blue Ridge Parkway and spend time in Shenandoah NP last weekend. Nope, didn't happen.

How are you being followed now? My oncologist says blood work annually is all I need. I guess after having so many doctors' appointments, etc. over the last year, it doesn't seem like enough. My PS says she will do MRIs at 3 and 5 years to make sure the implant is doing okay. I knew I was done with mammos, but I guess I thought there would be some additional screening, especially with the close margins. I really really really hate second guessing..... sigh.

ginger2345 · October 2013

This time of year I think we both need a fun time doing something.

My oncologist only does blood work also. I know it seems like more would be better, but actually there are so many false results from modalities like MRIs that without symptoms there's considered to be more potential harm than good. It's scary especially with the margin problem, but the bottom line is that survival is what drives testing not recurrence and studies have shown survival is not improved by doing a bunch of stuff as opposed to the basic blood work. I'm now starting on an every 6 months follow up unless I want to come more often.

For the first time, I noticed that you joined bc.org in 2005 after DCIS--we're more alike than I earlier thought! The fact that we're working on second time around doesn't help create a comfort level either.

Enerva · October 2013

Hi Ladies my margin was also not clear after my surgery thus march. My surgeon felt that she had taken all there was so she just sent me to Rad, now the next surgery will be in Dec to replace the TE with implants. I do worry about C, coming back but i like you now feel i just have to learn to live with that thought in the back of my mind since they will just see me every so often after that surgery. No more mammo or scans, only blood test and we need to be aware of how we feel if anything changes we must make them look into it. For some reason i feel after the TE are out i will start feeling better. i haven't have luck with it. Lets keep in touch Thanks for the info i ll also look again at my P report lol

Take care feel free to pm to exchange emails

ginger2345 · October 2013

Hi Enerva,

So you received radiation to take care of the positive margin before your TE placement? What kind of rads was it? If you have an anterior positive margin, could the surgeon take a bit wider margin when you get your implant?

Feeling safe is hard to come by since there isn't much good followup for breast cancer. After you get your permanent implant, you'll be able to feel like active treatment at least is ending. Maybe getting to moving on time. It's nice not to be going to docs all the time.

Enerva · October 2013

Oh no sorry i had Chemo first then surgery in March and they put the TE at that moment, then after waiting 17 days after surgery my Preport came and said my margin was not clear so i had Rad 5 weeks with TE right after the last fill. now they say rad sould have taken care for the cells that were left in the margin and if any in my lymph nodes cuz i decided not to have more lymph nodes removed yes i am nuts. i had both sentinel lymph nodes removed and the right one show positive along with my margin what got me upset is that they didnt test right away they close me up then wait 2 weeks for the p report. then wanted to remove more nodes. So i asked what are you doing about my margin? are you going in to take more tissue or are you taking my muscle? my surgeon said ohh nooo i took all i could take there is very minimal cells there, rad will take care of the margin. She had discussed my report with a team and they all came to that conclusion. then i asked if that is the case why rad can not take care if the lymph nodes? she paused and she said " you are right it can but there is a small risk you are taking" Then i said well i will take it. I do not want another surgery at this point. Ladies please hear me out, i was so upset, i told this Dr. at the time of my BMX to take everything she needed to take and as many nodes she thought necessary and then she waits 2 almost 3 weeks to tell me o i should open you up and take more nodes. Well i took my chance. now i will deal with the consequences so far so good. I am waiting now to get the TE out, and move on.

I did a lot if reading and i feel everything happen for a reason so i will just keep my fingers cross now. I also saw that in USA they test your tumor ,lymph nodes and margin right at the time of your surgery and they then make decisions as per what to do . But here in Cad they do it their way.

positive margin with implant

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