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Lumpectomy vs Mastectomy

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KimmyJ View Drop Down
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    Posted: Nov 17 2017 at 3:04pm
Hi everyone,
I was diagnosed with stage 2 TNBC in July. I’m 43 years old; mother of 2 young children. I just finished 8 rounds of chemo: 4 A/C and 4 Taxol. I just had my follow-up MRI and mammogram. Met with surgeon yesterday. My 5 cm mass is now a 2.5 cm gray matter, believed to be scar tissue. We won’t know if there are still cancerous cells until it is removed at surgery and sent to pathology. Same with lymph nodes. They’ve looked okay throughout this process, but we really won’t know until after surgery. The surgeon said I had an “excellent response” to chemo. So the question is, what type of surgery? The surgeon’s recommendation is lumpectomy with radiation. I have had genetic testing and I am negative across everything. I’m curious if anyone else has gone down this road. Has chosen lumpectomy with radiation over mastectomy. And what their experience has been. Thank you in advance for your help. xoxoxo
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123Donna View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote 123Donna Quote  Post ReplyReply Direct Link To This Post Posted: Nov 18 2017 at 12:10pm
Hi Kimmy,

Welcome.  This decision has been discussed many times throughout this group.  When given the option, it usually comes down to what is best for you.  A second opinion sometimes helps.  Ask your surgeon for statistics of recurrence of lumpectomy vs mastectomy.  I found some studies, but there may be newer research your surgeon can discuss with you.

"Still, this study also found that women diagnosed with triple-negative breast cancer who have lumpectomy and radiation don’t have a higher risk of local recurrence.

This is good to know. Many women and their doctors may automatically choose mastectomy for triple-negative disease because this type of breast cancer is more aggressive. It’s reassuring to know that women who may prefer to have lumpectomy can make that choice without increasing the risk of local recurrence."

Interesting thread discussing radiation and possible benefits of radiation after mastectomy for early stage:

http://forum.tnbcfoundation.org/radiation-and-possible-benefits-of-rni_topic10437.html

ScienceDaily (Oct. 31, 2012) â€” Research from The Cancer Institute of New Jersey (CINJ) shows that women with triple-negative breast cancer and no more than three positive lymph nodes following a mastectomy have a higher risk of local recurrence than similar women whose disease is not classified as triple-negative. The work will be presented as an abstract during the 54th Annual Scientific Meeting of the American Society for Radiation Oncology (ASTRO) in Boston this week. The Cancer Institute of New Jersey is a Center of Excellence of the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School (RWJMS)


To read the entire article:

http://www.sciencedaily.com/releases/2012/10/121031141721.htm


Summary:

"By further defining the risk of local recurrence in women with triple negative breast cancer, clinicians can better determine whether radiation treatment should be part of post-mastectomy therapy," noted the lead author of the research, Atif J. Khan, MD, a radiation oncologist at The Cancer Institute of New Jersey and an assistant professor of radiation oncology at RWJMS.


DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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SusaninVA View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote SusaninVA Quote  Post ReplyReply Direct Link To This Post Posted: Nov 23 2017 at 9:52am
Hi Kimmy,  I'm so sorry you are having to go down this road, but want to let you know I chose lumpectomy over mastectomy.  At first, my doctors just told me that lumpectomy was what was in my treatment plan, and I went along with their recommendations.  However, when faced with a third surgery to remove a remnant of DCIS which had led from the tumor, I was offered a mastectomy.  (Thankfully, did not have the third surgery because my radiation doctor offered a boost which he assured would get this - I trusted his judgment.)  I figured if later on, I was unsettled by my choice, I could go back and get the mastectomy (I don't know how insurance would handle this, though).  My tumor was 1.8 cm near my chest wall with two positive lymph nodes. I was told I was between a stage 2 and stage 3.  I believe most doctors give you more radiation with a lumpectomy, and I wanted the radiation!  I do remember reading an article (sorry I can't recall the title of it now) which offered statistics indicating that perhaps more radiation should be offered to women getting mastectomies.  Once I found out you can still have a recurrence with a mastectomy (it is not possible to remove all breast tissue on other side of your skin), I was at peace with my choice.  However, I deeply respect any woman who chooses mastectomy, or wasn't given a choice and had to have one.  I am two and a half years out from diagnosis, and am fine with my choice.  That being said, I will tell you that upon having my last diagnostic mammogram, I asked to look at the images.  I did have more scar tissue in my breast than I realized (from surgery and radiation) and that scar tissue shows up white on the imaging.  Along with some dense breast tissue (also showing up as white), I realize that finding a tumor now may be harder than before.  I will always insist upon 3-D mammography because of this.  I recently found out that many states have mandated offering a sonogram (ultrasound) to follow up a mammogram if you have dense breast tissue.  My beloved state of Virginia, however, always seems to lag behind and does not mandate this.  I really need to write my state representatives and get them on board!  Please make the decision which feels right for you. Let us know how you are doing - this is a wonderful forum! 
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