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Lumpectomy + radiation vrs. bilateral mastectomy

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pawwjw View Drop Down
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    Posted: Nov 13 2020 at 1:49pm
I have stage 2A TNBC. I have had 4 cycles of AC and 10 cycles of taxol with 2 to go. My MRI on 7/1/20 showed my 2 tumors (side by side) measured 3.8 x 1.3 x 1.7 cm. My tumors are localized. My MRI on 11/9/20 showed my tumors to be 3.0 x 0.3 x 0.7 cm. Chemo has made a difference. I have an appointment with my breast surgeon 12/1 and surgery 12/23. I am aware of the pros and cons of the surgical options. I am apprehensive of the reoccurrence factor and can't seem to find much info on it comparing a lumpectomy + radiation vrs. a bilateral mastectomy. Any info or experiences would be greatly appreciated. Of course, the decision is emotionally exhausting.
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cookie54 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote cookie54 Quote  Post ReplyReply Direct Link To This Post Posted: Nov 13 2020 at 6:05pm
Hi pawwjw, I am sorry that you are a tnbc sister but glad you found this site! So of course this is an individual decision as you already know but it's helpful to hear other experiences.

I was diagnosed in August 2016 Stage 1 no node involvement, my choice was a bmx. I chose that because I was tired of having biopsies after every suspicious mammo for nine years. The choice was easy for me, I was mentally done after 8 breast biopsies! I had A/C and no radiation.

Fast forward to June 2020 I had a axillary and chest wall recurrence, now Stage 3C. I had gem/carbo and Keytruda, just had ALND surgery. Starting radiation in two weeks and because I was not NED at surgery I will start Zeloda. So even if you decide to have a mastectomy there is the chance for chest wall and axilla recurrence. I attached this article https://moffitt.org/endeavor/archive/lumpectomy-vs-mastectomy/
it explains some pro's and cons. 
I think in the end you have to consider what you feel will give you the most peace mentally. If I can help you in any way I would be glad to.Hug



8/2016,IDC,Stage IA, Grade 3,0/1 nodes ER-/PR-,HER2-
9/2016 BMX;Reconstruction Saline implants
6/20,StageIIIC,Grade3ER-/PR-HER2-
6/20 Carbo/Gem/pembro
10/20 ALND 5/8 nodes
RT 11/20

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pawwjw View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote pawwjw Quote  Post ReplyReply Direct Link To This Post Posted: Nov 14 2020 at 7:50am
Thank you for your reply. I am sorry about your reoccurrence. Everyone's story sure is different. I am hoping that different experiences will give me more insight on lumpectomies + radiation vrs. mastectomies. My gut is not helping me at all in making my surgical choice. Did you have chemo before or after your mastectomy? You had reconstruction as well? I see you had AC; did you have taxol as well? This forum is great. I listened to an interesting podcast by Pat Prijatel. She said TNBC was only identified in 2005; she was diagnosed in 2006. So that helps to explain the lack of info out there. Take care and stay safe!
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cookie54 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote cookie54 Quote  Post ReplyReply Direct Link To This Post Posted: Nov 14 2020 at 7:32pm
Thanks, yes no two experiences are alike! I had chemo after surgery the mass was 8mm. I was supposed to have taxotere but unfortunately I had a reaction immediately after it was administered. Therefore I am unable to have any drug in the taxane family. So yes typically most tnbc patients get ACT. I did have reconstruction with implants as well. I had the expanders in during initial mastectomy and started the fills after chemo was completed. There is nothing like your own breast tissue that's for sure. However for me I wanted to be able to look in the mirror and feel kinda "normal" again.

Yes this site is a great place for information I feel especially since it comes from personal experiences. I know it has helped me tremendously on each step of my journey's. Be well.





8/2016,IDC,Stage IA, Grade 3,0/1 nodes ER-/PR-,HER2-
9/2016 BMX;Reconstruction Saline implants
6/20,StageIIIC,Grade3ER-/PR-HER2-
6/20 Carbo/Gem/pembro
10/20 ALND 5/8 nodes
RT 11/20

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pawwjw View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote pawwjw Quote  Post ReplyReply Direct Link To This Post Posted: Nov 15 2020 at 1:14pm
I know that with TNBC if one makes it to 3 yrs. after surgery, chances for reoccurrence decrease compared to other breast cancers. If one makes it to 5 yrs. after surgery, chances for reoccurrence drastically decrease. I understand that each case is unique but are there statistics comparing lumpectomy + radiation vrs. mastectomy for reoccurrence? I believe survival rate is the same for both surgeries.    
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cookie54 View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote cookie54 Quote  Post ReplyReply Direct Link To This Post Posted: Nov 15 2020 at 7:19pm
I am not aware of any stats other than the survival rate is the same. If there are actual numbers out there I'm sure your oncologist would know. It is obviously not an easy decision sometimes nor is it one any of us wish to make. If there are no further stats out there then you will have to ask yourself pro's and cons of both surgery's. Each surgery will have an impact on your life in different ways. All you can do is try to make the best decision based on your life. We are all being thrown so much information when we are diagnosed, it's difficult! I am always researching treatments etc. after all we are our own best advocate. Hang in there and just take things one day at a time.
We are all always here for support!

8/2016,IDC,Stage IA, Grade 3,0/1 nodes ER-/PR-,HER2-
9/2016 BMX;Reconstruction Saline implants
6/20,StageIIIC,Grade3ER-/PR-HER2-
6/20 Carbo/Gem/pembro
10/20 ALND 5/8 nodes
RT 11/20

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pawwjw View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote pawwjw Quote  Post ReplyReply Direct Link To This Post Posted: Nov 16 2020 at 2:55pm
Thank you for your reply. I hope all goes well for you!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote ellenofpaul Quote  Post ReplyReply Direct Link To This Post Posted: Nov 17 2020 at 6:54am
Hi Pawwjw.
I was diagnosed with Stage IIB TNBC on June 5th.  I went through 12 Treatments of Taxol and 3 of AC.  I didn't get the 4th because my WBC count got too low and landed me in the hospital.  It did however, push forward my surgery forward.  The chemo helped, though, because my tumor on 6/12/20 measured 2.4 X 3.4X 2.9 and shrank by 11/5/20 to 1.7 X 2.5 X 2.0. I was able to get a Lumpectomy on 11/16/20. It was what my surgeon recommended.  I'm optimistic now since the surgery went well and only 1 Sentinel Lymph node was taken.  I'll be scheduled for radiation starting in January.

Good luck

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pawwjw View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote pawwjw Quote  Post ReplyReply Direct Link To This Post Posted: Nov 17 2020 at 9:30am
Hi ellenofpaul,
Thank you for your reply! I was hoping someone who had a lumpectomy would reply! That is wonderful the chemo worked for you also! I understand that is usually why chemo is given first because the TN tumors respond well to chemo. Did you go with the lumpectomy because of your surgeon's recommendation or did you have other reasons? It sounds as though your timeline and journey are similar to mine. I would love to stay in touch with you.
pawwjw
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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 22 2020 at 11:16am
Hello pawwjw,

There are a few threads in the past discussing this very same subject.  The outcome rate is slightly better in the lumpectomy + radiation group vs the mastectomy group.  The key difference may be "radiation".  The mastectomy group did not have radiation.

Study participants were followed for a median of 7 years. One of the outcomes of interest was locoregional recurrence. This refers to a recurrence of the cancer in the breast, chest wall, or nearby lymph nodes.







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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pawwjw View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote pawwjw Quote  Post ReplyReply Direct Link To This Post Posted: Nov 25 2020 at 8:37am
Donna,
Thank you so much for all the info and links! That was exactly what I've been looking for. I've a difficult surgical decision to make and these links will help me make the choice that is best for me.
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