Lumpectomy or mastectomy? How did you decide?

I am strongly PRO lumpectomy if you have a choice, so will answer your questions from that perspective.

1. you are doing rads either way, so that is not an issue (I found rads a piece of cake after chemo).

2.If you want to be DONE, like I did, then a lumpectomy is the way to go. I missed a week of work & then was able to get back to my regular retinue. A mastectomy is a much more invasive surgery, has more potentially that could go wrong, and has a much longer recovery time. When you add reconstruction, look out! Go look at some of the reconstruction threads to see how much more down time, repeated surgeries, pain, unwanted side effects etc. can be added to your life. (Even if all goes well, it is going to take extra time & generally will require revisions down the road.) Another thing, reconstructed breasts have no feeling, so if your breasts are important to you sexually, that is something to consider.

3.My boobs are not perfectly matched now, but they weren't before, and wouldn't be with fake boobs either. I look fine in a bra & swimsuit, and since there is no chance that I will be asked to be a Playboy model, I am fine with that.

4. There is a slightly (very slightly) higher chance of a local recurrence. That would involve a mastectomy, not chemo. The chance of cancer spreading outside of the breast (which then would require chemo etc.) is exactly the same with either a mastectomy or a lumpectomy plus rads.

I had a lumpectomy first with one lymph node taken. (DCIS was my diagnosis from the biopsy) There was no family history of cancer, so I chose to start conservatively. However, the lumpectomy was quite disfiguring to my breast, and I also was very worried about long term side effects of radiation, since it would be on the left side, close to my heart. The results from the lumpectomy and node biopsy were good - they felt confident they had gotten good margins, and the small amount of LCIS found, they believed radiation would take care of. I talked with the radiologist, oncologist, surgeon, plastic surgeon, and my primary doctor, and finally decided to do a nipple-sparing mastectomy with reconstruction. For me, there was a great sense of peace when I made that decision.

Pain-wise for me, I would say the pain of mastectomy was significantly greater than the lumpectomy, but I didn't have drains for the lumpectomy. And reconstruction with a tissue expander is not exactly an easy pain-free process, although I found it manageable. I am going to have another surgery in two weeks to adjust the reconstructed breast with a variety of procedures. I really didn't expect to have to go through anything else after the initial exchange in June, so that has been a little bit of a disappointment. However, for me, I still am very happy to have done what I did. I have two friends who did the lumpectomy with radiation and are equally happy they did what they chose. They both said the process was not disrupting of their life, had a little skin irritation and did get pretty tired near the end of the treatments.

Keep talking to people and your doctors, but in the end, it is your body, your future, your personal preference. There does not appear to be a "better" choice medically if you are being given the choice. When I started thinking about how I want to live my life rather than just focusing on how I was going to get rid of the cancer, it really helped me in the decision process. What would give me more freedom from worry and stress and provide a good physical self-image?

I know you were looking for feedback on the radiation process, but I just checked back in this forum and saw your post, so thought I'd give you a response with my process.

I hope you get a good result with the oncotype.

Robin

Almost 7 years out. Zero SEs from radiation then or now.

* edited to add that knightzoo mentioned that she will be having radiation with either procedure

Wow- lots of emotion in this thread- I had to take a little break reading it. I think because its so important and intensely personal- if we do something and someone else does something else did we do the "wrong" thing. I was diagnosed by bx with invasive ductal carcinoma- blessed with a fabulous health plan and team that gave me a ton of information including the published research on every possible option and said it was my choice to do any, all or none of it. For me, no treatment or purely alternative treatment was not something I would consider so I sat down and did what so many on this site have done, read the research, read your posts and listened to my heart. I went from my initial "just get it out of here" bilateral mastectomy with immediate reconstruction to my final decision of having sentinel node bx, needle localization and lumpectomy. My lymph nodes were normal and my margins were clear. I started radiation last week for 16 treatments- no boost. Oncotype score 13. I already have calcifications on the non-operative side and have had an aspiration bx there 3 years ago that was negative- As much as I brought this up not one physician (surgeon, medical oncologist, radiation oncologist, plastic surgeon) thought that should change my decision-making one way or the other.

This is not for or against any option this is my specific journey- The lumpectomy is still a partial mastectomy- I think its important to say that. I am a small-breasted woman and after they got done taking the mass and the area to ensure margins my breast is about half the size of the non-surgical side which was not that big to begin with.... The good news is my nipple is there and has feeling- the whole thing is not great to look at without clothes. With clothes I have to wear a bra with some padding to even things out.

I expect radiation to make the surgical breast even smaller. Radiation is a time-consuming, daily reminder that you have cancer. It has its own emotional punch and mine is left-sided so yes- I worry about heart & pulmonary side-effects. I can't compare it to chemo myself but my mom (Survivor lymphoma & esophageal CA) preferred radiation side-effects so again is personal. Radiation can only be done once so once you have had it, you won't have it again on that side even with recurrence.

I am at peace with my decision which is the most important thing and I have a treatment plan with a good prognosis- if "it" comes back- I will deal with those facts.

The lifemath.net site is kind of interesting to play around with and see the numbers based on your specific scenario.

PRB, just remember its your body and your decision alone. You are the one who must be comfortable with what you choose. We are each different and therefore can react differently to rads, hormonal therapy and even chemo. As you have probably read by now and may have caused you even more confusion. No one can predict ahead of time what reaction our bodies will have to what we decide. I feel it really boils down to our gut feeling. Not saying that there won't be any second guessing after the fact, but that is only human nature. Just my humble opinion.

It is good to hear why/how others made their decisions, to ask questions, to consult with medical personnel, to make informed choices of your own. But once you do; close the chapter, more forward. Whatever you choose is what was right for YOU at the time.

Oh PRB, your post makes me sad. The way to close the chapter is to open a new one. None of us would have ever picked to have this happen, but you can MAKE positive things happen because of it. If there are things you have been involved with & don't enjoy anymore, use this as an excuse to get out of them. If there are things you've always wanted to do, but have put off.....do them; whether it is joining a Book Club, a choir, taking painting lessons, learning Chinese, going on your dream..... whatever. Be nice to yourself; get a facial, go out for lunch with friends, buy that really cute, age-inappropriate outfit & wear it because who the hell cares what anyone thinks! And really appreciate all the little blessings that happen every day; the sunrise, lilacs in bloom, playing board games with your family, whatever is good; find and enjoy these things. Opps, sorry, I will get off my soap-box. Best wishes to all.