[Debbie L.]

Good questions, Mama Bexar. And I like your sense of humor, especially that you are able to summon it up at a hard time like this!

This is such a personal decision. There are no right or wrong answers for a straightforward diagnosis of early breast cancer -- only your OWN right answers. As I'm sure your providers have said, for a basic early stage breast cancer, there is no difference to survival between lumpectomy vs. mastectomy. You didn't mention the plans for the axillary lymph nodes -- will they do a sentinal node biopsy?

Lumpectomy is the simplest/easiest surgery, although simple mastectomy (without reconstruction) is quite straightforward, also. As Pat94 mentioned, some people (with negative lymph nodes) choose mastectomy specifically to avoid radiation, either because of fears about that part of treatment, or for convenience (avoiding the drudgery, cost, travel, and/or loss of work involved in daily treatments for weeks). There have also been studies questioning the need for radiation after lumpectomy in older women, but that decision probably depends more upon general health (life expectancy) than upon any specific age.

It's true there's a very slightly-higher risk of a recurrence in the breast after lumpectomy (vs. mastectomy) but it's quite small -- your surgeon or oncologist should be able to give you some numbers to describe that risk. Keep in mind that it's the (unlikely) distant (metastatic) recurrence that would threaten your life, not a local (in the breast one). But I do hear (and get) your concern about avoiding the need for further surgery at a later date. If it were me, as I said above, I'd want to get some numbers about how likely it would be that more surgery would ever be needed, before making the lumpectomy/mastectomy decision.

If you choose mastectomy, whether to do just one or both is again a personal decision. Symmetry (whether flat or reconstructed) appeals to some and drives their decisions. Another driver of the choice for bilaterals is that no further screening (mammography/MRI) is needed. Others value having one functioning breast over other factors.

Sometimes it helps clarify your thinking and feeling to write it out -- how you feel about each option, the pros and cons (in your mind) of each.

If all of us on this list shared with you what we decided, and why -- you'd see that there were many different "right" choices, and that most are satisfied with what they chose, for many different reasons.

Have you gotten a second opinion about your surgery options? It's always a good idea to do that (and if at all possible, at an NCI-designated Comprehensive Cancer Center). You may not hear anything different from what has already been discussed, but you will gain peace of mind and prevent later regret, knowing that you based your decisions on the best information and advice you could gather.

Good luck, keep us posted. This time of gathering information and making treatment decisions can be the hardest part of the breast cancer experience.

Debbie Laxague