Lumpectomy vs masectomy

_kxlxm_ · July 2018

I'm new so I apologize if this topic has been asked and covered several times. I have just returned from the oncologist. I have ILC Stage 1 (so far) ER+/ER+. Not sure about lymph nodes yet. Best guess on size is <2cm. So here is my question: lumpectomy vs mastectomy. I originally thought lumpectomy. But I have small breasts and after surgery and then radiation, I'm not sure how successful reconstruction surgery will be. I don't like the idea of a mastectomy and honestly don't know anyone who has experienced one. I do not have anyone at home that could be of any real assistance so any information on recovery or what to prepare for would be great. Any experiences or thoughts you ladies could share would wonderful. The surgery will be scheduled for the next couple of weeks.

Moderators · July 2018

Hi _kxlxm_ and welcome to Breastcancer.org,

While this is a very individualized decision, we're sure others here will be by shortly to help explain the decisions they made and why.

In the meantime, you may be interested in checking out the main Breastcancer.org site's page on Lumpectomy vs. Mastectomy, which walks through things to consider while making this decision.

We hope this helps and we look forward to supporting you through your surgery -- whatever you decide.

--The Mods

Icietla · July 2018

Welcome, _kxlxm_. I am very sorry about your being diagnosed with cancer. I am going to post on your thread here some links to some other BCO discussions with information that will likely be helpful to you. Please read through them and also through the content linked therein.

I had bilateral mastectomy -- modified radical mastectomy and ALND on the side known to be diseased, and total (simple) mastectomy on the other side. The surgery took down to and including the deep fascia on each side. I was ready to return home about three hours from the start of that surgery. I did not have a Plastic Surgeon following the General Surgeon to tidy up my chest, and I did not have any reconstructive procedures. My arm use is only very limited. For years before my diagnosis, I had been struggling long and hard to fasten and unfasten poorly supportive front-closing bras. I could not put on nor take off back-closing bras without assistance. My breasts were burdensome to me. Even if my breast cancer had been of a type other than ILC, I would have wanted bilateral mastectomy.

From ultrasound and mammographic imaging before surgery, my tumor appeared to measure .8 cm. (8 mm). 2.1 cm. (21 mm) of tumor tissue was removed in my excisional biopsy, and there was some more tumor tissue left in my breast until my next surgery. The tumor tissue taken in my first surgery fell apart during measurement, so the total size of my tumor configured as grown could not be determined.

The area from which your axillary lymph nodes will be taken may be the sorest area after your surgery, and for the longest time.

Prior to the surgery, tracer injections are administered in the most sensitive part of the (diseased) breast. For a half hour prior to the injection procedure, I had EMLA numbing cream and an occlusive cover on the site. I moaned through two of the shots and I screamed through the other three shots. Then I wept. It was by far the worst physical pain I have ever experienced. [This is saying a lot.] Ask the Hospital personnel to do whatever they properly can to make the tracer injection procedure tolerable for you.

You may be advised to have chemotherapy. Either a weak positive on progesterone receptors or diseased lymph nodes might make for a chemotherapy recommendation. If any lymph nodes are found to be diseased, or if any tumor tissue is found in very close proximity to the chest wall, that might make for a recommendation of radiation treatment. If there is uncertainty as to need for chemotherapy in addition to a long course of anti-hormonal medicine, OncotypeDx testing may be done, and the results (predicting likely benefit of chemotherapy in addition to endocrine therapy) may help guide that particular decision.

Your Doctor can order a longer hospital stay or some home health care visits for you if you would need that.

ILC can be very sneaky.

https://community.breastcancer.org/forum/5/topics/864847?page=1

https://community.breastcancer.org/forum/71/topics/862161?page=1

These discussions cover a lot about preparing for and recovering from mastectomy surgery.

https://community.breastcancer.org/forum/91/topics/857555?page=1

https://community.breastcancer.org/forum/71/topics/861298?page=1

https://community.breastcancer.org/forum/5/topics/865531?page=1

Lula73 · July 2018

I'm so sorry you're having to make this decision. It's not an easy one I know. I'll share with you my experience...

I had calcifications in left breast which truggered an order for an mri which showed ~1cm IDC in the right breast. Could've chosen lumpectomy on left and mastectomy on right to avoid rads but opted to go ahead and remove both breasts. I did a ton of research on reconstruction options and chose immediate DIEP flap reconstruction. No regrets whatsoever.

Like you, I'd never had a mastectomy before and had no idea what to expect. I have been very pleasantly surprised. With DIEP flap reconstruction my breasts feel just like my originals did before I had kids. They feel like part of me to the point that unless I consciously think about it I don't notice any difference from before mastectomy on a day to day basis. The skin has retained its feeling in about 85% of my breast. There is no feeling in the nipples but they still respond to touch/cold. The breasts are warm and soft, they move with-me, they'll age with me, and they feel to My DH like the originals too. Since I had the mastectomy and the reconstruction during the same surgery I was never without breasts. Since I was able to do skin and nipple sparing mastectomy it's hard to see where I had anything done.

Lumpectomy will automatically come with radiation followed by anti-hormone therapy for the ER+. Mastectomy may mean you get to skip radiation. Anti-hormone therapy will still be given. Depending on your final staging you may or may not require chemo. Statistically, lumpectomy with rads and mastectomy have same survival rate. However, mastectomy has a lower recurrence rate. Mastectomy with recon often allows for better symmetry when a large portion of your breast needs to be removed. Opting to remove both breasts vs just 1 reduces risk of developing BC in the other breast and allows for better symmetry. Have you had genetic testing done yet? If you haven't, please ask your dr to do it before you make your decision. If it comes back positive then mastectomy would be the recommendation and will save you a Surgery vs not waiting for the results.

I'm going to post a link at the end of this reply to the center where I had my mastectomy and reconstruction done (yes i traveled to go there) as well as a link to a video series called, 'I wish I'd known' that is an excellent resource for anyone contemplating mastectomy and/or reconstruction no matter where they're going for their surgery and no matter what type of reconstruction. Feel free to ask any question, I'm happy to answer them.

Don't let anyone rush you or pressure you to make a decision quickly. BC is a relatively urgent matter but it's not an emergency. Most women go 6-10 weeks between diagnosis and surgery. There is no rush. Take the time to ask questions, research, ask more questions, think and then choose the options that leave you with a feeling of peace.

www.breastcenter.com

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

_kxlxm_ · July 2018

I haven't had the MRI done yet. Thank you for telling me your story. I'm trying to find out more information on lumpectomy and radiation with the possibility of reconstructive surgery. There is so much more information on having a mastectomy which I'm not crazy about. I have small breasts (34A-32B) and feel that having a mastectomy and a rebuilt chest area would feel very alien to me. I could be wrong of course! All the research is starting to freak me out. Strangely enough I am not concerned with a recurrence. Maybe it's because I am new to this journey I just feel like "Okay, let's get this out, do the 4 weeks radiation, it's going to suck but the goal is back to normal." Oh, and my nasty little cells are VERY estrogen hungry at 90% so my other concern is finding an IA I can tolerate since it looks like I could be on it for awhile. Travelling isn't really a good option for me (although I'm not too far from New Orleans and have looked into that facility and would love to talk to you more about it, I would like to message you if that's okay). The other concern is having a major surgery isn't really a great option for me. I don't live near family and do not have a significant other. But I guess if it has to be figured out, so be it. It has felt overwhelming to think about how in the world am I going to keep my life functioning and do this alone. I would like to add that I do like my surgeon and feel very comfortable with him. He realizes a lumpectomy is my preferred option and they are going to set up a consultation with a plastic surgeon who does reconstruction to learn more. I also live in a city with a university medical center and want to consult with them as well regarding reconstruction and the options. Ha! I've reread what I wrote and I do sound a little scatter brained, don't I? I just want to move forward and look and feel normal again.

Lula73 · July 2018

not scatterbrained at all. This is absolutely normal at this stage of the game! Feel free to PM me. If you want to talk live I’ll PM you my number. In the meantime, take your time deciding and don’t let anyone rush you into a decision -cancer is urgent but not an emergency.

Lumpectomy vs masectomy

Comments

Categories