Passing on MX with dirty margins after 2 lumpectomies?

have you had an mri? Sometimes when they keep getting dirty margins it’s because there’s another area of DCIS that they couldn’t pick up on the mammo or u/s. They assume the area is clear, but sometimes it’s not. After 2 attempts, I’d want an mri to confirm that it’s not more widespread than originally thought. Mammos and U/s are good tools but not 100% accurate-I’m living proof of that along with hundreds of other women on these boards. If MRI comes back positive for additional areas I would do the mx.

The tamoxifen works by basically starving any lingering cancer cells of estrogen which they are using for food. Recurrence can happen regardless of mx, lx, rads, and/or chemo. For a Mom, it is all about being here for your kids. Doing whatever you can to up your odds of being here and healthy for the long term is what’s important even if that means bigger surgery than lx in the short term.

I didn’t find recovery from mastectomy to be all that hard (and I am much older than you) - and the peace of mind it brings is priceless

Same. MRI could worse cancer in the other breast. It wasn't palpable or visible on mammogram. I also had a positive mastectomy experience.

Kernaz, not having clear margins is what led me to BMX with DIEP Flap reconstruction. I had two areas of concern and my breast surgeon was confident there was no breast tissue left in those areas...only skin and muscle. My MO and RO were considering treating it with rads. I feared that if there was a cell or two left that it would metastize to my chest wall. I had no lymph node involvement so I had a simple mastectomy...no lymph nodes removed and no muscle from the chest wall removed. My postmastectomy pathology report came back clear. My BS was right but I am so glad that I made the choice of BMX with reconstruction. My MO and RO said that it was like taking a sledge hammer to a fly! I did not need chemo or rads because my Oncotype Score was 14.

I was completely against mastectomy at the beginning of my diagnosis but as I went through my options the path to being cancer free became very clear.

DCIS is not as simple as docs discuss. Think what is best long term for you and your child.

Routine annual 3D mammogram led to my recent diagnosis of DCIS grade 3.( 2-3 cm in one quadrant) Had two opinions at world renowned specialty hospitals.

After core biopsy had 3 positive and 3 negative margins(<2mm). Because I have a small breast that would be too disfiguring for multiple lumpectomies, I opted for unilateral MX with a SLNB, I also wanted to avoid radiation the first go round. Also my surgeon said she performed 4 lumpectomies on a patient to try to preserve some breast until she could get all postiive margins. Surgeon felt it outcome was very poor buy what patient wanted. A lot of decisions are in your hands.

BIG SURPRISE- Found 75% cancer in mybreast post MX with clean nodes.(not original 2-3CM) Negative margins are huge red flag.

My theory in treating this disease is keep as many tools as you can in the toolbox.

If you opt for lumpectomy and need radiation (may not need) your skin may be compromised if need MX down the road and want reconstruction. DCIS is a recurring disease and very treatable but a pain. MX reduces recurrence substantially to almost nothing. Not trying to scare anyone.

I am doing very well 2 weeks out with MX and expander. Immediate reconstruction with MX standard option where I live. My skin was too thin.

You are doing right thing to take time and consider all options. Know you will find right option for YOU! Thinking of you.

You may want to consider getting a second opinion as well. My DCIS and LCIS did not show up on my MRI. My BS said it is not uncommon for MRIs to miss certain kinds of DCIS.

I personally would want more reassurance than "thinks she got most of it." How many mms clear were the margins? Most surgeons want at least 2 mms and some say 3 mms.

After two lumpectomies without clear margins I had a double mastectomy with immediate, direct to implant reconstruction and am glad I did because the relief of knowing that the cancer is gone is priceless. No radiation or tamoxifen necessary and I don't have to worry about it any more. Pathology showed DCIS was scattered throughout the left breast (so more lumpectomies would not have gotten it all), and previously undetected LCIS was in the right (noncancerous side). Sentinel node was clear. Recovery has not been bad at all -- frankly it has been far easier than worrying about the cancer was. (Side bonus: no more mammograms!)

you’re welcome, Kernaz! Good luck with MRI. You had genetic testing? If not, get those results too before deciding bilateral or unilateral. Since mx path of some type is the treatment plan, now is the time to decide on recon and type of recon (implants or natural tissue reconstruction). The same amount of thought and research you put into this decision needs to go into the recon decision and the recon type decision too. Here’s a link to a great set of videos for women undergoing breast surgery regardless of where they’re having it done. They tell you a lot of things other docs leave out (hence the name of the video):

https://www.breastcenter.com/2018/05/01/i-wish-id-known-dr-ordonye-speaks-to-ypo-about-modern-breast-cancer-care/

I'm glad you are getting some answers and finding the path forward that makes you the most comfortable. I don't know that I would choose reconstruction again after all I've been through with long recoveries and complications. It's a lot of work to have a couple of blobs on one's chest.

I opted for BMX because of suspicious spots on the contralateral side which turned out to be nothing. I hope your imaging comes out clear on the other side so that the decision is your own. Having a usable arm after surgery and having sensation are really nice perks of a UMX. More surgery = higher probability of complication. I thought of mine as a "matched set" so that if one went, so did the other. I have a different perspective now. Less is more!

Best wishes on your MRI today. I hope you can just rest afterward. Those things really wear me out.

oh, and I was also able to avoid the SNB...after two LX with only DCIS, they marked the sentinal node but did not take it...pending pathology...which was clear of invasive so without SNB I don't have to fear lymphodema...

I am diagnosed with stage 2 breast cancer. I had two lumpectomies and the anterior is still showing positive margins. My genetic testing came back negative and they stated no chemo because my score is 17. First my doctor stated she can’t do anything more and the rest radation has to take care of the rest. I went to my appointment yesterday and oncologist stated my doctor called him and they want to reevaluate me and see if they can offer me another surgery. Before going with my 2nd surgery I asked my doctor if I should do a mascemtomy and she stated no because it’s close to my skin. Has anyone been in my situation and what advice can be given to me?