Tubular but close to nipple - Quadrantectomy or Mastectomy?

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katcar0001
katcar0001 Member Posts: 621
edited November 2014 in Surgery - Before, During, and After

Hi all,

I was diagnosed Nov. 22 with Tubular Carcinoma, Grade 1. I have consulted with two surgeons and both say they can't guarantee complete margins because the tumor is right on the border of the areola.

The one doctor, trained in Spain, does not do lumpectomies--only quadrantectomies to ensure a wider margin. He said that he could clear under the nipple and then send the tissue to the pathologist during the procedure to check for cancer cells. If found, he'd continue with a mastectomy. Am I taking too much of a chance going with a quad? What would you do, given the low grade of the tumor and absolutely no family history? Would you go for the mastectomy as "insurance"?

I tend to be risk averse, and I am kind of a fragile person. I don't do well with uncertainties (and there are plenty with breast cancer anyway).

Try to save the nipple or not?

Thank you, Kat

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  • katcar0001
    katcar0001 Member Posts: 621
    edited November 2014

    Anyone? I know it's TG in the U.S..... just was hoping for an opinion. I guess Tubular is too rare.


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  • BayouBabe
    BayouBabe Member Posts: 2,221
    edited November 2014

    Kat - sorry no one is responding. Don't know anything about tubular or quadrantectomy. However, I was able to spare one nipple, and am glad I did. Makes that breast still seem like me, if that makes sense

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  • doxie
    doxie Member Posts: 1,455
    edited November 2014

    I had IDC not tubular. Not sure how that would have made a difference.

    My tumor was immediately below the skin right beside my nipple. They would not do a needle punch biopsy, they said, because of the pain it would cause. Hyper sensitive area. I had a surgical biopsy. If cancer my BS said he would then have to go back and take the nipple even if margins were clear.

    I now have a reconstructed nipple. Not perfect, but cancer free so far. I had the option of mastectomy, but preferred to keep my breast. The concern over not removing the nipple is that loose cancer cells could migrate to internal lymph nodes via the nipple.

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  • katcar0001
    katcar0001 Member Posts: 621
    edited November 2014

    That helps a lot, thank you both Bayou and Doxie. Tubular is IDC but it is a low grade, non-aggressive type not known for spreading to the lymph node, although there are cases. That is why I have been on the fence. So far, I am saving the other breast.


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  • labelle
    labelle Member Posts: 721
    edited November 2014

    I think a lot depends upon how you feel about radiation treatment. With a quad (which is a kind of lumpectomy) radiation will be in your future. With a mastectomy, probably no radiation. Tubular cancer is different, it's slow (so you have plenty of time to decide/learn and make good choices) almost never spreads beyond the breast and has a good prognosis/little chance of metastases. But it is rare, good studies re tubular breast cancers are hard to find, but it is different enough from reg IDC to merit its own category and conservative treatment seems to be appropriate.

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  • katcar0001
    katcar0001 Member Posts: 621
    edited November 2014

    Your answer seems to match what little I have found online--mostly Medhelp.org. I definitely would prefer no radiation but it's a tough call--save the nipple or not. I suppose he could do a nipple sparing MX but then there is always that chance of stray cells ending up there. I really appreciate your input, Iabelle.


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  • Akitagirl
    Akitagirl Member Posts: 142
    edited November 2014

    Hi there,

    I had IDC with a 1.7 cm tumor that was just beneath and a bit lateral to the areola/nipple. My main goal was to do a nipple-sparing mastectomy with reconstruction. Unfortunately, when I had the MRI prior to surgery, we found an extension of the tumor that went directly to the nipple. Therefore, we performed a full mastectomy and the surgeon "cored" out the nipple, leaving the areola. The results were much better than I expected, and the plastic surgeon and I are discussing a future surgery to take half of my right nipple and putting it onto the left side to give it a little more even appearance. That might be a consideration?

    Also, I agree about the radiation. It is the plastic surgeon's worst enemy and if you want to complete reconstruction with great outcomes, I might recommend a mastectomy over a lump/quadectomy - in order to avoid any radiation. Then, you have lots of options for reconstruction.

    Just some food for thought!

    Sincerely,

    Akitagirl

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  • katcar0001
    katcar0001 Member Posts: 621
    edited November 2014

    How interesting, Akitagirl, I had not heard of taking the nipple but sparing the areola! Not sure that is an option for me but will definitely ask. You are voicing exactly what I am thinking--that I will get better results with mastectomy and no rads for reconstruction. I have huge nipples (my ex said they look like Captain Crunch Crunchberries, haha), so that sounds like a viable option for me. I am feeling more and more reassured, and you ladies have been so helpful. I cannot thank you enough. Off to the TE forum to find out more about those.

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