LUMPECTOMY/RADIATION VS. MASTECTOMY

Hi Golden,

Lots of questions to answer.

1. SNB = Sentinel node biopsy. In my case, this was done at the time of my lumpectomy.  Prior to the lumpectomy a series of about 4 tiny injections are made around your nipple area. Sometimes this is done with anesthetic.  Mine wasn't.  The purpose is to inject a dye that will follow the lymph pathways of your lymps nodes.  The sentinel nodes are socalled because they will be the first ones the cancer will go to if it has spread to the any lymph nodes.  The dye is used to light up these nodes so the doctor can see them when doing the surgery.  Pathology tested mine for cancer while I was still in surgery, so I had the results when I woke up.

2. Can't answer the insurance question, but my assumption is yes.

3. I  don't think there is an average age.  It seems from reading the posts on this board that the younger the woman, the more aggressively the cancer is treated.

4. I personally only know of one woman, my surgeons wife who had a lumpectomy 11 years ago for IDC and has had no recurrence. Of course, there are tons of women out there, but they are most likely no longer posting on a support board.

5. Reconstruction can be with expanders/impants, or autogenous flap reconstruction.

6. You can check into Mammosite radiation. It is a five day procedure.

7. Don't have the answer, but I haven't heard of this.

8. Are you referring to after a mastectomy?

My DIL's mother had a small DCIS tumor and a lumpectomy.  They did not get clearn margins, so she opted for a bilateral mastectomy. She has Kaiser insurance.  She had to fight with her surgeon to get a prophylactic of the opposite side.  Her thinking was she never wanted to deal with this again.  She has had no radiation and will not take HT's.  She has also been waiting a year to meet with a plastic reconstructive surgeon.

My story is, I was 51 when diagnosed. I had a small IDC .6 cm x .7 cm, er/pr+, no nodes, Stage I, Grade II.  I had a choice between mastectomy or lumpectomy and radiation as you do.  Except, because yours has been identified as DCIS, the assumption is you have no nodes involved. Reconstruction may be difficult after radiation, but certainly not impossible.  I chose lumpectomy and radiation.  If there had positive nodes, I would have had to have chemo as well, and not been able to make a choice about it.  I chose this tx because I didn't want to loose my breasts. It was my decision, not my SO's or my family's.  My sister would have made a different choice had it been her.  Making the choice for someone else can lead to regret and resentment, in my opinion.  I was fortunate that the side my cancer was on was my bigger breast, so with the lumpectomy it actually ended up making them the same size.  So, cosmetically it worked out.  The doc removed quite a bit of tissue and I had .6 cm margins at the closest. 

I like my breasts and am quite attached to them.  I also like them sexually and the thought of not having any sensation in them was too much to give up.  It's traumatic enough that it had cancer in it.  My boyfriend would have supported me and stood by me no matter what I decided. I was lucky that I could make that choice.  So many can't. 

I guess I don't understand why they are trying to get clean margins with biopsies.  Do you mean you've had 2 lumpectomies already?  Biopsies are diagnostic procedures.  Lumpectomies are to remove the cancer and achieve clean margins, then proceed with radiation to "clean up" the area as added insurance that all the cancer is gone.

I'm sorry this is so long.  I know others will be along to help you out too.  The thing is, everyone is different and their decisions are as unique as their diagnosis.

I'll keep you in my thoughts and prayers.

Brenda in VA 

If you are over 50, had a non-lobular tumor, are hormone-receptor positive, and less than a grade 3, I know of an alternative to radiation.  I had it done in August.  PM me if you want to know the details.

Dear Brenda,

     I guess I just had to add m 2 cents worth to this conversation. I was diagnosed 5 years ago with DCIS stage 0.No node involvement, in the left breast.Decided  to go with lumpectomy & radiation, was told this was just as good a treatment as mastectomy.Now this past March, had a biopsy for a "shadowy area" in left breast again.Found ALH & LCIS, which are considered a pre-cancerous condition. Decided to have a mastectomy(which Insurance covered) to prevent further diagnosis.Well, lo & behold, the pathology came back that I had Invasive Lobular Carcinoma in the left breast again, and over an 8 cm area.The surgeon was blown away by this, we were not expecting to find this, it did not show on an MRI that I had done.She said I had just literally saved my own life by deciding to have the mastectomy.No node involvement again,and did 4 rounds of chemo, and now I am attempting reconstruction. We had put expanders in after the mastectomy, but the previous radiation has caused all kinds of problems and we have had to remove the left one twice.Now having a tram flap to the problematic left side,and will remove the expander on the right afterwards and put in an implant to match the tram flap project.If I had to do it all oevr again, I should have just had the mastectomy the first time around, now I wouldn't  be going through all of this! I was just too scared at the time to have one.But think about it.With a lumpectomy, you are leaving behind tissue for cancer to return to.With a mastectomy, most of that is removed and your odds of recurrance are alot less.And radiation can cause all kinds of headaches with reconstruction.You usually don't need radiation with a mastectomy.That is just my feeling on the subject.Hope everything goes well for you, wishing you the best.Feel free to send me a personal message if you would like. Jax

HI I am 48, single, was dx Jun 07 with IDC, her2+, er/pr-, stage2, 5cm+ tumor, no node involvement (so far) in left breast.  I had neoadjuvant chemo (AC for 3 mths) to shrink tumor to allow for lumpectomy because I do not want a mast (same reasons you gave).  I was told tumor shrunk but surgeon still wants to do mast - too many microcalcifications.  PS says that they can do skin sparing mast but not save nipple.  I have already backed out of scheduled surgery once - rescheduled for Nov 9th. PS wants to impant tissue expander then.  I still have to have more chemo and rads - no choice! After rads they are advising a DIEP or SIEP recon - because I am a belly dancer and need my belly muscles.  I have been very depressed at thought of losing my breast and not having a choice.  Feel fortunate that you have a choice.  My preference would have been a lumpectomy and rad.  Coworker had lumpectomy and chemo with rad and loves the results - she is only 42 and felt she was too young to have mast also. Good luck!!! I wish none of us had to make  these decisions - but do what you feel is right for you, not others, and no regrets.  I had friends and family saying have mast from beginning; but knew I had to do everythig I could to save my breast so that I would not think later - "what if... ?" esp. if research down the road could keep me from losing it in case of recurrence.