Positive margins after bilateral mastectomy
I had a BMX on Friday, although only had a tumor on my right side. I met with my surgeon today for routine follow up and he said that I had positive margins and will have to go back into surgery this Friday. I had tissue expanders placed during the first surgery. I was so shocked because I thought this was only a possibility with lumpectomy. How can I have some cancer left when they took out all the breast tissue? Also, he said that this might mean that I will need radiation. Can they do that with my tissue expanders? Also, how will he know where the tumor edges are if the clip was removed in the first surgery? Anyone who has experienced this or can help me understand, I would greatly appreciate.
Comments
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Bumping ...Can anyone help JBLmom? -
Have you seen your pathology report? It should tell you where the positive margins are. Yes you can do radiation with TE in place. I am.
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I haven't seen it yet, but the surgeon talked about it with me. I'm thinking that the tumor was closer to my skin than I had previously thought. Glad to know that I can do radiation with tissue expander.
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jblmom -- I recall from reading one of my surgical reports that they colour the sides with a dye so they know which margin comes from where -- that way they would know what area that they to remove additional tissue from -- good luck
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Hi Jblmom: Sorry you are going through all of this. Even once we think we have a plan in place, there often are complications and surprises. I am not certain what you are dealing with, but I had extensive DCIS, which I believed to be a relatively good thing compared to some of my options. I had to have a mx of my left breast as I am very small breasted and a lumpectomy would have basically been the same thing. I was so relieved to find out that it was completely DCIS, no node involvement and then the cruncher. A positive posterior margin. My BS would not do further surgery as she stated that it was like going in blind. DCIS does not show up so there is no way of knowing where to take more tissue. She felt my risk was still small and did not recommend radiation. But my odds of a recurrence suddenly went from 1 or 2 % to 13%. I was not happy. So I met with a radiologist and we reviewed studies that are now showing benefits of radiation following a mx. Reduces rate of recurrence to 7.5% (basically by 50%), but adds the risks of radiation. I was so torn by this decision, but opted for the radiation. I have never regretted my decision. I have nothing to add regarding the effects on reconstruction as I did not go that route. Sorry you have this added complication. As though there is not enough already to face and decide. Good luck with your decision.
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thank you TB90! My MO seemed like this is really no big deal, but honestly, it was completely shocking since I went the the BMX because I just want to get the cancer out! I have young children, and I want to do whatever I can to minimize recurrence .
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JBLmom Im so sorry you are going through this. Honestly I thought I knew a lot about breast cancer and this shocks me! May I ask if you are being treated at a university based teaching hospital? Honestly I would get a second opinion before I would let the same surgeon to go back in. Don't want to over step my boundaries but this is a really upsetting especially for a young mom. Please keep us posted. Good luck.....
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Unfortunately, doing a MX does not mean that ALL breast tissue is removed. Best wishes moving forward!
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my surgeon explained that my tumor was just very close to the wall and he wasn't able to visualize it. I'm starting to learn in this process, that despite all my knowledge about process, procedures, labs and reports, there are still going to be the unknowns
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jblmom mom - stinks you have to go for more surgery but glad theyre going back. I know of a few people who had rads with either imants in or expanders, with no problem. My ps asked me friday if i 2as having rads, i didnt know. Depends on final path after my bmx. He said if indid, it woukd be fine. Just might take longer to get the exchange done.
Tb90- glad you're getting the radiation. I don't trust dcis. If i hear one more time "it's just dcis..." nothing is "just" when it comes to cancer. A very close friend had dcis 7 years ago in one side, 1 year ago in the other. Both times lump with rads. Never had node bioosy because it was "just". 3 weeks ago was dxd with metastatic cancer, liiver and maybe lung. Do everything you can to zap it! I'm confused that your surgeon would not think radiation was necessary when there is known dcis in there. Glad you saw the rad onc anyway. Sounds like you're on a good plan.
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I am one who had a BMX with DCIS remaining in the original tumor bed afterwards. This was a complete surprise it was never detected. I did chemo prior to surgery to shrink my original tumor. This was deep against the chest wall. I did 5 weeks of rads for this with my tissue expanders. Was able to do a tissue flap reconstruction 4 months later. The radiated breast is much firmer than the prop side. Good luck. Better to get it all removed if possible. I could not get mine removed so am counting on rads to have killed the rest of it.
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sorry to hear they still couldn't get it surgically, but glad radiation worked with your tissue expanders
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