Surgery mishaps, missing clip, positive margin

I'm posting on behalf of my wife, this is long so thanks in advance for reading, tldr for those who don't want to read the whole thing.

Diagnosis is, 36 yrs old, IDC < 2cm, HR+,PR+, HER2 -, who had a BMX two weeks ago. Tumor size 20mm, Invasive component was 7mm and she has a positive anterior focus margin with DCIS. Clear Nodes.

TLDR; Surgeon overlooked then can't find clip marking suspicious un-biopsied area; Unsure if tissue which the clip marked was taken; Positive margin found and exact location of removed tumor unknown, the surgeon placed stitch to mark location but it was accidentally removed by PA; Accuracy of doing a re-excision to clean margin without precise location of removed tumor; Should we consider Radiation Therapy.

We are starting to have some concerns, questions, and anxiety about a clip that is missing post-surgery, a positive margin status, re-excision, and the need for radiation.

Here's what happened,

The surgery took a really long time, was told it would be 3-4 hrs, and ended up being 6. The surgeon said she'd come see us after her part was done and before reconstruction (about 1.5 hrs), ended up leaving us in the waiting room without any info or updates for 6 hrs, which caused some serious anxiety. After the surgery the surgeon comes out and tells us that they could not find one of the biopsy clips, and they spent a bunch of time looking for it, and did x-rays during the surgery trying to find it. The surgeon said she did not know about the clip before surgery, but midway into the surgery the radiologist who placed it, happened to come into the surgery and ask about the second clip. The surgeon acted very surprised and said the clip was not noted anywhere (even though it's on page 1 of biopsy report) and must not be in her and that it likely fell out, or was somehow removed with the other tissues. The surgeon was really down playing it saying it's not a big deal to leave the clip in her and that her main concern was that she got the tissue which it marked; and being that she took all the tissue possible she must have also removed any tissue the clip was marking.

A week later on the initial follow up the surgeon has now changed her mind and says the clip is likely still in my wife, actually fairly certain it was, and sends my wife to get x-rays done to locate the clip. Her pathology report indicated a positive anterior margin and the surgeon wants to remove more skin to clean the margin and at the same time go in after the clip.

So we get the x-rays done and we cannot find the clip.

Next day we go see the Reconstructive surgeon whom was also present during the surgery, he indicates that the expanders and drains in my wife could be hiding the clip due to the bloom they put off. He suggests a CT scan after the drains are removed to try and locate the clip, which is still pending.

The biospy report, on page 1 clearly explains the second clip, which apparently the surgeon completely overlooked. It says that "due to the superficial and posterior location a biopsy was not performed, however a heart clip was placed to demarcate the site of these additional calcifications".

The positive margin is anterior and I think not related to the clip site. During surgery the surgeon placed a stitch to mark the tumor location so that she could take more skin as if needed in the event of a positive margin. Problem is her PA removed the stitch the morning after the surgery, apparently not knowing that it was supposed to be left in to identify the location. The surgeon now has to guess where to take skin to clear the margin.

Our concerns and anxiety are starting to mount. The surgeon keeps trying to say it's not a big deal but they are clearly trying to find this clip. Further the location of the re-excision cannot be exact due to the stitch that marked the tumor location being removed.

The surgeon is saying that she thinks my wife does not need radiation and the re-excision will clean the margin.

We are having doubts and think that we might need radiation (meeting with radiation oncologist this week), due to both the possibility of the tissue marked by the clip still being present, and the location of the tumor and re-excision location being questionable.

• What are your thoughts?
• Has anyone had Post Mastectomy Radiation Therapy? What were your reasons?
• Can radiation be accurately done now that we don't know the location.
• This feels like a couple of crucial screw ups to us, and we are wondering if it's a bigger issue than we are being told.

thanks for reading, any help or advice, much appreciated.