bbbddd168

I'm sorry for your diagnosis. Coming up with the right treatment plan after diagnosis is a stressful scary time. If I understand you correctly you are leaning towards Lumpectomy followed by Mastectomy, and you're wondering if that is reasonable. I personally would think that is reasonable.

I myself have had several breast surgeries including Mastectomy, Lumpectomy, Reconstruction and Revisions. I may have another Lumpectomy and Revision in the next month if biopsy comes back as a reoccurrence.

Cancer diagnosis, treatment plans and doctor visits seems like such a whirlwind of scattered thoughts and racing hearts, sometimes you'll leave a doctors visit more confused than before. My advice is to go with your gut and listen to your own inner voice. You know what is best for you.

All my best to you

Is it possible that you might need radiation even after a MX? Yes. Not likely, given that it appears that you have an early stage diagnosis, but possible if the cancer is close to the chest wall and the surgical margins are too close. Or if the cancer turns out to be very large. Or if it turns out that you have several positive nodes.

So what do you do? No one here can tell you - it's too personal a decision and we all look at these choices differently, from our own perspectives. You have to do what feels right to you. Going with a lumpectomy first, to find out the final pathology and whether you have nodal involvement, and then proceeding to a MX, is a reasonable option. Is this what you want to do? Or would you prefer to avoid having two surgeries if you could be reasonably certain that you won't need rads after the MX? If you would prefer one surgery, the question is whether you have all the information you need to make your decision.

Do you know where the cancer located? Is it anywhere near the chest wall? If not, then that reduces the likelihood that you might require rads after a MX.

Second, have you had an MRI? While it's not foolproof, an MRI sees things differently than a mammogram or ultrasound, and in combination with your previous imaging and your biopsy results, might be helpful in determining the size of the cancer, whether there is anything else lurking in your breast that might be worrisome, and whether your nodes appear to be involved. No method of screening, including an MRI, will pick up a small amount of nodal involvement but a small amount of nodal involvement likely wouldn't require rads anyway, if you have a MX.

If you are comfortable with starting with the lumpectomy and making the next decision from there, then do it. If you would prefer going straight to a MX, then see what you can do to get more information about how likely it is that you might require rads even after a MX. Both your surgeon and oncologist told you that you wouldn't require rads after the MX. Ask them how certain they are about this, and why.

I can tell you I’ve had rads on both sides and had no concerns about my heart. The technology is so good these days. My RO looked me in the eye and told me (twice) that she would not irradiate my heart. I did have to do the breath hold thing for the left side but it wasn’t a big deal at all.

As Beesie says in her excellent post, it's a very individual choice. Personally I'd want to go right to the BMX and skip the extra surgery and radiation.

Great that you've had the MRI and that there is no visible lymphatic invasion. From the description, "middle depth", it sounds as though the cancer is not near the chest wall or the skin. If I've interpreted that correctly (you should get this confirmed by the surgeon or oncologist), this would bode well for not needing rads after a MX unless there is some nasty surprise, such as a new area of cancer - which is unlikely since the MRI didn't see anything.

Decision making is alway hard because we can never be 100% certain about anything until we have the final surgical pathology. Usually the pathology from surgery is close to what was expected from the imaging and biopsy however there can be differences, sometimes good (a smaller than expected cancer, for example) and sometimes bad (more cancer than expected, or positive nodes).

Good luck with your decision and with the surgery. Let us know how it goes.

I was told by the RO that there would be no damage to the heart or lungs. Several months later, I had an appointment with a cardiothoracic surgeon for a completely unrelated matter. I mentioned that I'd had radiation, thinking of skin changes should I need surgery. He thanked me for bringing it up, and said they'd have to test me for heart damage. I told him what the RO said, and he just smiled sadly and said that there is ALWAYS some damage. That left me not sure what to think. Then on my latest CT scan (for yet another unrelated issue) last October, there appeared some new smudges on my lung, which the radiologist who read it determined was scarring from radiation. So take what the RO says with a giant grain of salt. Mine apparently lied through his teeth.

Please don’t assume that a mastectomy means no radiation. I supposedly had a 1.5 cm tumor and no node involvement. Oops, never mind, 2.5 cm tumor, micro mets in one node. Radiation. The best laid plans...

Good luck, I hope it works out well for you

"I saw your post at other place " I believe the % of recurrences that are IDC is somewhat higher after a MX than after a lumpectomy." , why is this?

Does it mean I have less recurrence rate if I do lumpectomy+radiation than mastectomy?"

.

The comment you reference was made in a post about DCIS. The point I was making is not at all relevant to your situation, with an invasive cancer diagnosis.

As for what I recommend that you do, I don't know. Only you know what the best decision is for you. Two people with exactly the same diagnosis and health issues might choose different options, and for each person, it can be the right decision.

Wow medical opinions seem to differ greatly anymore. I had a mastectomy (left only) following 2 biopsies that showed NO cancer in the nodes. Nope, it was there. Only in 1/3 and micro with EE but there nonetheless which has now complicated my decision making. I am right now trying to decide if I should go forward with radiation despite the RO's opinion the risks outweigh the benefits. My oncotype score was a 4. The EE concerns me, but the RO wasn't concerned about it at all. The risks are more in connection with my reconstruction. I am still young and care what the final outcome is but would rather reduce my risk even further.

I'm torn. But as others have said, never assume a mx will eliminate the need for rads.

I was obsessed with this topic in September and is one of the reasons I dumped my BS. She told me no radiation or chemo or ALND with mastectomy unless greater than 3 nodes. No further explanation. This made no sense to me, but I thought lets see what happens first as MRI showed no node involvement. I came out of surgery with one affected node and final pathology 2 macro nodes, 2 mm and 3 mm. FYI this does happen often, not that uncommon. BS didn't visit me in the hospital, sent trainee and wouldn't talk to me until final pathology came back. I was distraught. I researched the NCCN guidelines and saw recommendation for mastectomy 1 to 3 macro nodes and no ALND than either ALND or radiation recommended. When I tried to talk to them about the NCCN guidelines, trainee had no idea what I was talking about and BS was rude and horrible. But the RO on her tumor board didn't hesitate to recommend radiation supposedly because I had LVI, no talk about the nodes, but since the info was coming from the BS second hand I couldn't have an intelligent conversation about it and I didn't meet the RO for another month. So all that worrying for nothing, I was ready for a fight. I also asked her if the RO would radiate my chest also? She said of course not, she was offended like I was implying she didn't get clean margins. But when I met with him, his plan was chest and nodes. And they are on the same tumor board. Additional opinions from Rutgers and Sloan agreed with doing radiation. I want radiation because with 5 nodes taken out it is possible to have additional positive nodes, especially with ILC that spreads in sheets. Oh and another consultation tells me she left too much breast tissue behind also. You never know what you are getting. That being said, I am also afraid of side effects, especially lung cancer, my mom died of lung cancer. But it is on my right side so a little relief regarding the heart. My RO is doing 28 regular and 7 boost. I just finished week 2. Overall not that bad. I have a slightly swollen throat and was really tired the first week, but now I am on steroids for some lingering chemo issues, and feel like the energizer bunny.

The guidelines don't recommend radiation for micro invasion, but if I had it I would still want radiation. I read an article on how microinvasion should be treated also from 2009!!. https://www.breastcancer.org/research-news/2009060...

They give radiation automatically to lumpectomy patients regardless of node status, just doesn't make sense to me. I never saw the study Beesie provided, thanks Beesie, it appears it is what the NCCN guidelines are based on. This needs to become more well known, as my BS who is head of surgery apparently is not aware of it. Especially with the push to not do ALND anymore.