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Lumpectomy vs Mastectomy

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Asovey View Drop Down
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    Posted: May 16 2018 at 10:27am
Hello Everyone!  I am excited to say that I will be having my last chemo on Friday!  Yeah!  That brings me to my next step - surgery - on this journey.

Yesterday I met with my surgeon.  I had always assumed that I would be having a lumpectomy as that was one one of the reasons to have the neo-adjuvant  (sp?) chemo, but now the surgeon is bringing up the possibility of a mastectomy because my original mass was large.  As of now, there is no palpable mass in my breast.  I have never had any palpable lymph nodes.  My PET scan in December did show minimal lymph node involvement, but when I went for a lymph node biopsy, they could not find any lymph nodes on ultrasound.

My MO and Dr. Traina have told me that there is no difference in survival outlook between a mastectomy and a lumpectomy with radiation.  Is this something others have been told also?  What types of surgery have others of you had?  Of course, I want to do whatever will give the best long term outlook, but a mastectomy is not at the top of my list.

I will be having a breast MRI tomorrow and my surgeon will discuss my case with the Breast Cancer Team at the hospital next week.

I would appreciate any input any of you would share.

Ann
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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: May 16 2018 at 7:23pm
Hi Ann,

You are asking very good questions.  You are correct, the survival results for mastectomy only vs lumpectomy plus radiation is about the same.  There was even a discussion a while back about the benefits of radiation for early stage women who opt for mastectomy would benefit with the addition of benefits.  


I'm assuming you tested negative for genes associated with breast cancer?  This could change the decision for lumpectomy vs mastectomy.  

Many times, it comes down to a personal choice. 

Donna
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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Post Options Post Options   Thanks (0) Thanks(0)   Quote Warriorkat Quote  Post ReplyReply Direct Link To This Post Posted: May 18 2018 at 12:22pm
Hi Ann,
I came to ask the very same question. I still have 5 weeks of Taxol but just met with the surgeon. He originally said a lumpectomy might not be an option because of the location of the cyst. Now however it is no longer detectable on palpating and has given me the choice of lumpectomy + radiation or mastectomy (which if I choose will be a double because that’s my preference). He said either offers the same survival and the same low recurrence rate. He’s ordering a mammo/US for more info.

So my question is now around radiation and potential local effects and long term effects. Anyone have experience with lumpectomy/radiation? If I choose mastectomy I have decided on a double with no reconstruction. He says it’s my decision and to factor in psychological health because medically either route will get me the same statistical result.

Advice?!
Gratefully,
Kat
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Post Options Post Options   Thanks (0) Thanks(0)   Quote mainsailset Quote  Post ReplyReply Direct Link To This Post Posted: May 18 2018 at 10:05pm
So question, if you choose a dbl mast are you not getting radiation? I was told the radiation, even after a dbl mast, was obligatory...
dx 7/08 TN 14x6.5x5.5 cm tumor

3 Lymph nodes involved, Taxol/Sunitab+AC, 5/09 dbl masectomy, path 2mm tumor removed, lymphs all clear, RAD 32 finished 9/11/09. 9/28 CT clear 10/18/10 CT clear
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Lisa s Quote  Post ReplyReply Direct Link To This Post Posted: May 19 2018 at 2:21am
I had chemo lumpectomy and radiation. Radiation was fine until last 2 weeks. Then had burned skin but not awful at all. Was healed within 10 days. Radiation site back to normal within a week or two. Def better than masectomy. My doc said can always do mastectomy later if God forbid i would need treatment again
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Asovey Quote  Post ReplyReply Direct Link To This Post Posted: May 20 2018 at 1:24pm
I do think this is a really personal choice. Some people seem to feel a mastectomy will give you less of a chance of reoccurrence. (Not true). Some people do not want radiation so they go for mastectomy, but you still might require radiation even with a mastectomy. I do know there are some factors that favor a mastectomy like larger original tumor. I was also told that closeness to the nipple, chest wall or skin play a part. No just got the report from the breast MRI I had last week and I think it sounds good, but I will wait to hear my surgeon’s recommendation next week after the breast cancer team meets. So many things to consider!

Ann
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Warriorkat Quote  Post ReplyReply Direct Link To This Post Posted: May 20 2018 at 1:42pm
Per lymph node biopsy pre chemo confirmed by recent ultrasound I do not appear to have lymph node involvement (surgeon will test pathology of sentinel node again during surgery) and my tumor was <5 cm at 4cm BUT because it was a “benign” cyst with cancer only in the wall of the cyst staging based on size is not accurate. With these parameters radiation is not recommended though I’ll know more post surgery.

So at this point, not having yet met with the radiology oncologist I’m looking at lumpectomy + rads OR mastectomy. Seems like lumpectomy would be so much less invasive but I would like to avoid radiation. And I’m wondering if I’d stay more sane not having scanxiety every time I’d have to go for mammograms. Also, radiation can lead to long term issues. I just do not know what makes the most sense. My pathology shows metaplastic characteristics which can also be more difficult so another reason to consider mastectomy
Gratefully,
Kat
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