Changing my mind to lumpectomy?

hray - of course you have questions, its a big decision! I think you are smart to consider the pros and cons of each type of surgery so that you are making an informed decision rather than one based on an emotional reaction. Firstly, I am brokenhearted that you even have to wrestle with this at such a young age, it is so very unfair. I am old enough to be your mom and I struggled with the very same question. My oncological breast surgeon initially offered lumpectomy and 5 day brachytherapy rads as an option. I had large B cup breasts and a tumor that was a minimum of 2.6cm and located at the outside edge of the breast kind of where an underwire in a bra would end. I had surgery prior to chemo and I was concerned that taking that much of my breast in that location would pull the nipple to the side and bug me due to the asymmetry. My secondary concern was that this very palpable tumor did not show up on my mammogram, only on ultrasound. I did not trust that imaging going forward would pick up a recurrence or a new primary. I had been closely monitored (imaging every six months) for quite a while, but I still had extremely dense breast tissue even nine years after surgical menopause, so I was difficult to image. How was your tumor found? Was it easy to see on mammogram, or did it require additional forms of imaging to detect? I realized that for me personally, bi-lateral mastectomy was the only surgery that would give me peace of mind knowing that my larger tumor in my smaller breast couldn't been seen on the first line of imaging. I ended up having a bunch of unseen DCIS with my triple positive IDC on the cancer side, so much so that it had also moved into the lobules, and also had copious amounts of atypical lobular hyperplasia and atypical ductal hyperplasia in the non-cancer breast, so potentially a ticking time bomb - surprise! Have you had MRI done? It is important to have a full picture of all that is going on in both breasts before a surgical recommendation can be made. I had always had numerous cysts in both breasts simultaneously, all the time, so self-exam was pretty useless, further complicating things. Several questions to ask yourself - if the lumpectomy creates a non-symmetrical breast, will you be ok with that? Not that this will be a foregone conclusion, but is a possibility depending on your anatomy and how much tissue needs to be taken. Your surgeon should be able to address this and should be discussed. One option, if you are a candidate, is talking to a plastic surgeon who does oncoplastic work so that they can rearrange some tissue during your lumpectomy and fill in the lumpectomy defect for better appearance. Something else to consider, if you did lumpectomy and radiation now it may complicate mastectomy with reconstruction later should you choose that later. Radiated skin doesn't stretch well and can eliminate some kinds of reconstruction down the road - usually implant - leaving autologous flap surgery as your only option. It is important to consider whether this is something you want to undertake if you would choose to reconstruct. Previously radiated skin is less of an issue if you choose to go flat but can cause some healing problems even in that scenario. How do you feel about the level of imaging surveillance you will need if you choose lumpectomy? Some really struggle with their worries and emotions when it is time for mammograms after lumpectomy, and particularly if something shows up and further imaging is needed. You would likely be on an accelerated schedule of imaging for some period of time following your active treatment, so it is important to give that some thought. There are people here who have had a lumpectomy and later opted for mastectomy, your surgeon should be able to tell you whether your insurance will cover the later surgery - usually they have to code it so that it is medically necessary - but I think for the most part it is covered. You would potentially have additional expense with a new deductible in a new insurance year for the additional surgery. I sure wish you didn't have to make this decision, it is hard, but particularly so for a 27 year old. Wishing you the best, hang in there.

I'm sorry are dealing with this so young definitely. The choices you have to make at the beginning is very hard sometimes and easy to question.

I had ER+/PR+ and HER2nu- cancer. My breast surgeon told me it was "nice cancer" if that is any help to you in your decision.

I did try lumpectomy myself at first. They do check for "clean margins" (which I did not have) and then I had re-excision to get more after that. Still not and at that point the decision to mastecomy was done.

You don't have to rush right into mastecomy if you do not want to though. If you can get clean margins you can have your non-cancer side reduced and lifted to match if you want since you are so young your may prefer to do that. I was already into my 50's by the time I got my mastecomy and kind of wanted my non-cancer side to stay "me" so I am totally lop-sided at this point but it is ok. I have no cancer in me right this minute to my knowledge.

Best wishes to you and for speedy recovery. With hormonal meds afterwards you should have a nice life ahead of you to look forward to.

hray, it is completely your decision, and these decisions are very personal for all of us. I can give you my experience having done both a lumpectomy and a mastectomy at a young age.

For me, the lumpectomy was preferable: it was lower impact physically, mentally, emotionally, and sexually. After the lumpectomy it was easier to put all this cancer stuff behind me. I still looked the same, felt the same, and was "at home" in my body. I also had no chronic pain with the lumpectomy, because the lumpectomy is just not as invasive as a mastectomy. After the mastectomy, I had much more physical discomfort, and my body was forever changed. I still feel disfigured by that surgery, and that is difficult from an intimacy perspective.

Sometimes a mastectomy is necessary, but my personal opinion is that a lumpectomy is preferable if it's an option. Here is a study which also found that for young women, quality of life is more negatively impacted by a mastectomy than a lumpectomy. You might find it to be an informative read: https://www.mdedge.com/obgyn/article/191479/breast-cancer/qol-poorer-young-women-after-mastectomy-bcs

hray - I am so glad that you image well, and that your tumor could be seen with mammography - that is a bonus at your young age, since younger women usually have denser tissue. My personal opinion - and that is all it is - you may be well served by lumpectomy. It will preserve feeling in your breast(s), allow you to move forward more quickly, and since you would not be looking for implant recon in the future the radiation piece after lumpectomy is potentially less damaging and wouldn't limit your options going forward. Since you are hesitant about mastectomy, I would listen to that voice in your head for the moment. Once your breasts are gone, they are gone. Lumpectomy allows you a minute to breathe and think about the future. Two things - look at talking to a plastic surgeon about oncoplasty during lumpectomy if there will be a significant defect after surgery, and also check and see if your surgeon can have the margins looked during surgery. There is an instrument called a Margin Probe (see link) that can help minimize the need for re-excision after lumpectomy, which normally happens about 20% of the time. I don't know how commonly this is used, but it is worth asking about. Good luck!

https://www.breastcancer.org/symptoms/testing/types/marginprobe

Such a difficulty decision and I am sorry you have to be in this situation at this young age.

I was diagnosed with a small cancer and I was recommended lumpectomy. I decided to go for BMX with nipple spearing for these reasons:

1. I didn't want to be fearful anytime if I would feel something weird in my remaining breast.

2. I didn't want to worry when I would had mammograms, etc.

3. I was concerned that if it happen once, my body has the predisposition to create breast cancer again.

4. I had a dense breast and mammograms didn't show much. I would have to fight with insurance to do other screenings.

5. Lumpectomy would create a different shape of the breast and look different from the other breast - a cosmetic problem that wasn't very important when you fight cancer but it is there.

6. I didn't want radiation that comes with Lumpectomy.

I can say that having BMX was a good decision for me. Pros:

1. cancer was found accidentally in the other breast after it was removed.

2. recovery from BMX was easier than I thought

3. I don't worry about breast tests anymore

Cons:

1. I didn't expect that I would lose the feeling of breast area. It is getting better but feels strange.

2. Implants are not the most comfortable thing. One side is fine, the other one feels tight when I stretch my arms or exercise.

I also thought all these women around the World pay for implants for cosmetic reasons, it would be OK for me to have a normal size implants, same size as I was before.

It is your call and how comfortable you would feel. Good luck!

Ditto what MinusTwo said - you can ask your MO to recommend a radiation oncologist closer to home.

The second time I did radiation I opted to do it far-ish from home, and my cancer center was able to set me up with a temporary housing for patients for that month. That might be another avenue to explore if necessary.

When I was first diagnosed with cancer I have dense tissues. They thought mine was .7 cm and very small originally so they did not take out much the first time around. Then when there were not clean margins she called me to tell me and we scheduled the re-excision to take a little more. Then after that time around and no clear margins they said it had to go. My tumor size was really 5 cm and not small at all.

Mine could NOT be felt like yours at all and was found on mamo only. Breast surgeon even said what a good job the radiologist did in finding it because if he had not marked where it was on there she would have had a hard time seeing it.

Yours is more defined I think. It is still what she called "nice cancer" as far as cancer is concerned. Some are very aggressive and harder to treat. Taking a pill a few times a day for many, many years beats cancer any day in my book.

Best wishes.

hray - if you are going to Birmingham for rads there is an American Cancer Society Hope Lodge there that can offer free housing, see link. We have one here in Tampa, co-located at Moffitt Cancer Center, an NCI center, it is a wonderful facility.

https://www.cancer.org/treatment/support-programs-and-services/patient-lodging/hope-lodge/birmingham/staying-with-us.html