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Lumpectomy vs. Masectomy
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lcorino View Drop Down
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    Posted: Sep 13 2009 at 6:56am

I have just completed my 7th round of chemo ( Taxotere) with one more to go on October 1st, 2009.  Once that is completed I will have an MRI to determine if my tumors which were 2.5 cm's in size have shrunk enough to make me elligible for a lumpectomy.  At this point we cannot even feel the tumors anymore so it is a real possibility that I will have the option of a lumpectomy.  My surgeon seems to be pushing me in this direction however I am not so sure that is the best bet.  

As I see it, if I do a lumpectomy it leaves more chance of reaccurance,  is more disfiguring ( I'm a 34B so how much can you really take out and not be disfigured?), I will have to have radiation which can cause other issues, and then if they don't get clear margins I am looking at additional lumpectomy's that may lead to masectomy anyway.  If I do a bilateral masectomy I realize I will lose my nipples, sensation, blah blah blah but it lowers the risk of reaccurance, no radiation and heck, I could end up with perky boobs.  My ultimate goal here is to never go through this again.  Ever.  If I could have a lumpectomy and go through the rest of my life without this coming back I would definately take that option.  I would love to keep what God gave me but if having a lumpectomy means going through this again, forget it.
 
So what are your thoughts?  I am looking for some insight from those of you that have been in my shoes and made a decision one way or the other.   What did you do, and how did it turn out?  Would you have done things differently? 
 
Any and all suggestions and insight are welcome!  :)
 
Thank you!
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unklez View Drop Down
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L Corino,

1. Lumpectomy + Radiation is equivalent to Mastectomy in terms of local recurrence and distal occurrence.

2. We were in the same situation as you and believed mastectomy would be needed until we saw the surgeon at Sloan who recommended lumpectomy wholeheartedly. DW is 34A and had 2 focal points in the breast (one of the focal points turned to be benign but we did not know that before and they both had to be removed) with the cancer lump @ 2.9 cm. It is now 3+ weeks since lumpectomy and we are very pleased with the cosmetic results. The breast has regained almost the full sensation.

3. Take a second opinion from another breast surgeon please.

4. Have you been tested for BRCA? If not, do get that test done. It is a simple blood test that takes 1-2 weeks to come back. The result of that test would be a big consideration. From a worry free perspective, bilateral mastectomy + immediate reconstruction is highly recommended should you turn out to be BRCA +ve or if better looking and matching breasts are hugely important to you and you do not mind bigger and more surgeries.

5. Have you had node biopsy yet? How many nodes were +ve? Radiation is still needed if you have >4 involved nodes or if the tumor was too close to the chest wall. Radiation is sometimes still considered if >1 involved nodes. Other than the inconvenience of daily visits, radiation is a piece of cake once you have been thru' chemo.

I hope this helps.

Good luck in making your decision and with your treatment whatever you decide.

Regards, Unkle

Wife Dx: Jul/09. Age: 37. Size: 3cm. BRCA: -ve. Lumpectomy: Aug/09. Micromet 1/9 node. Chemo Start: Sep/09. E5103. DD ACB-> DD Abraxane (Taxol reaction). Zometa (S0307). Canadian Fraction Rads.
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lcorino View Drop Down
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My surgeon did say that lumpectomy + radiation were equivalent to a masectomy but is that the same for TNBC also?  I thought it would weigh more into the equation? 
 
I have not been tested for BRCA. What does that tell you?
 
I have had a node biopsy and one node tested positive, thankfully. 
 
I am curious...if I have a lumpectomy and radiation, how does that effect reconstruction if they end up having to do a masectomy anyway?  I have heard that once you have radiation you have to wait 6 months before they can do any type of reconstruction if they end up doing a masectomy. 
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123Donna View Drop Down
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Lori:

My plastic surgeon told me that if you have radiation, it makes it harder for reconstruction with a mastectomy later.  The reconstruction would need to be with the TRAM abdominal flap.  Hopefully there will be other members that have had lump + rad, then mastectomy that can share their experiences.

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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unklez View Drop Down
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No one has studied the efficacy of Lumpectomy + Radiation vs Mastectomy for TNBC specifically. For now the statistics are believed to be identical. Also know that risk of death is not when breast cancer is in the breast, but when it goes to another part of the body.

Please do get BRCA tested. This is very important.

One node tested positive out of how many? Is axillary node dissection planned or done? This is very important because you may end up getting radiation even with mastectomy depending on how many nodes have been tested and how many were positive out of that.

Radiation changes quality of the area's skin and tissue. Many plastic surgeons will tell you that they won't be able to do a good reconstruction after radiation. Run away from those guys. You need a plastic surgeon who has experience in reconstruction after breast cancer treatment. Several techniques have been perfected for that scenario, including TRAM Flap, DIEP Flap, LD Flap based reconstruction, all of which give more natural and longer lasting breasts. One or more of these will work for you.

If you do get mastectomy, you will probably want immediate reconstruction for emotional reasons. That raises another consideration. Should you need radiation to the axilla region after implants or expanders are placed, they can get damaged and/or fail. Does the doctor recommend axilla radiation?

Yeah, so many things to consider. The main take away is that two more pieces of information are needed:

1. BRCA test
2. Whether radiation to axilla is recommended by your medical team

Regards, Unkle

Wife Dx: Jul/09. Age: 37. Size: 3cm. BRCA: -ve. Lumpectomy: Aug/09. Micromet 1/9 node. Chemo Start: Sep/09. E5103. DD ACB-> DD Abraxane (Taxol reaction). Zometa (S0307). Canadian Fraction Rads.
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unklez View Drop Down
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Originally posted by 123Donna 123Donna wrote:

Lori:My plastic surgeon told me that if you have radiation, it makes it harder for reconstruction with a mastectomy later.  The reconstruction would need to be with the TRAM abdominal flap.  Hopefully there will be other members that have had lump + rad, then mastectomy that can share their experiences.Donna


Harder in the sense that LD Flap option may become harder but TRAM and DIEP flap options remain open.

Wife Dx: Jul/09. Age: 37. Size: 3cm. BRCA: -ve. Lumpectomy: Aug/09. Micromet 1/9 node. Chemo Start: Sep/09. E5103. DD ACB-> DD Abraxane (Taxol reaction). Zometa (S0307). Canadian Fraction Rads.
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Hello lcorino,
 
We have had many discussions in this forum regarding what you are asking about.  Try the search box and I believe you will find information.
 
 
 
Hope this will help.
 
It is a very personal decision.
Stage 2 2003
Stage 1 2007
BRCA 1+
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This question has haunted me.  My biopsy failed, so I went into surgery to get my diagnosis.  Thankfully my surgeon got clean margins.   After surgery I went for a 2nd opinion to another breast surgeon at another facility, then saw two oncologists.  ALL of them said they were "happy" with my lumpectomy situation - and wouldn't have changed their minds if we were having this discussino pre-surgery w/ a successful biopsy.  SIGH.  This is the 1st article my oncologist pointed me to:
 
 
She trained at the Mayo.  Getting a 2nd opinion is the best advice you will ever receive!  I hope your testing shows that tumor shrank down to nothingness! 
IDC, 2.2 cm, Stage IIb,lumpectomy 1/30/09 ACx4,Tx4 36 rads
6/1/16 Local recurrence same breast, same spot 1.8cm Carb.4x every 3 wks, Taxol 12x once wk. Dbl Mast. PCR!! Reconstruction fail, NED!
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JuneLee View Drop Down
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Hi, lcorino,  By now you've probably made your decision based upon your
research, medical advice, gut feeling, etc. etc.   I've read the other replies
and, for me, a masectomy and no reconstruction was best.  I had been
told that because there were two cancers in one breast, I couldn't have
lumpectomy.  After masectomy chemo and radiation were not recommended, so off I went to get back into a life.  I'm 71 and am doing
well.  4 years into remission.  I am very active physically and socially.  I'm
happy with my choice.  I don't wear a bra but choose t-shirt and vest or
equivalent.   I'm, still happy with my choice.  Accept what must be done and get involved when there is latitude for your personal decision.  Good
luck.
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Dear LCorino,

What did you decide and how is the treatment going?

I need to correct my earlier post re lumpectomy + radiation being same as mastectomy in terms of risk of recurrence.

For distant recurrence and overall survival, the risk is same after lumpectomy + radiation compared to mastectomy.

But for local recurrence, the risk after lumpectomy + radiation is 5-8% compared to mastectomy which is 2-5%. So if your goal is to never have to worry about BC again, historical data shows that mastectomy offers slightly better chances. Doctors typically do not consider this a significant difference (because studies can have statistical errors, sampling errors, and no two women are alike, advances in surgical and radiation techniques etc).

Just wanted to make this correction for future reference.

Also here is an article that someone posted on bc.org.

http://www.sacbee.com/273/story/2259751.html



Edited by unklez - Oct 17 2009 at 8:38am
Wife Dx: Jul/09. Age: 37. Size: 3cm. BRCA: -ve. Lumpectomy: Aug/09. Micromet 1/9 node. Chemo Start: Sep/09. E5103. DD ACB-> DD Abraxane (Taxol reaction). Zometa (S0307). Canadian Fraction Rads.
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Another article based on a survey completed by a MSKCC doctor last week.

http://www.mskcc.org/mskcc/html/95077.cfm



Edited by unklez - Oct 18 2009 at 6:49am
Wife Dx: Jul/09. Age: 37. Size: 3cm. BRCA: -ve. Lumpectomy: Aug/09. Micromet 1/9 node. Chemo Start: Sep/09. E5103. DD ACB-> DD Abraxane (Taxol reaction). Zometa (S0307). Canadian Fraction Rads.
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I have opted to have a bilateral, nipple sparing mastectomy.  With this type of cancer I want to have the lowest % of reaccurance possible.  I really do not want to go through this again. 
 
I have my MRI tomorrow ( Oct. 19) to see what is left of the tumor after chemo and my surgery is scheduled for Oct. 28th. 
 
Thanks for all your advice... I'll let you know how it goes... 
 
I still can't believe this is happening.. 
 
 
 
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Sunris View Drop Down
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lcorino,

Best of luck on your upcoming surgery. Please let us know how you are doing when you get home and feel up to it.

Dawn

Age 43 at DX

DX 3-09 IDC 3.9cm

TN-Stage2-Grade3

Taxolx9, FACx2, halted TX,

Lump.8-25-09..rads x 8wks.
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Will do!  :)
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Good luck Dear LCorino.
Please keep us updates on how things go.

Wife Dx: Jul/09. Age: 37. Size: 3cm. BRCA: -ve. Lumpectomy: Aug/09. Micromet 1/9 node. Chemo Start: Sep/09. E5103. DD ACB-> DD Abraxane (Taxol reaction). Zometa (S0307). Canadian Fraction Rads.
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