lumpectomy vs. mastectomy?

[4angel]

I am looking for thoughts on the choice between having a lumpectomy vs. a mastectomy. I was diagnosed in Aug. 2012 with stage IV, having many mets to the liver but only one large primary in the right breast. It's very low, almost out of the actual breast tissue, but it was large. I finished 16 rounds of taxol, having both herceptin and perjeta every third week, also zometa as they have an area of bone they are watching. I will have the ovaries out early March as the breast area is Er+. All the Drs. involved feel removing the original site is a good idea, but two surgeons have each suggested different paths. The mass reduced by 1/2 during the first 8 rounds of chemo but has been stable since. If I choose a lumpectomy it will be a large area. If I choose the Mast. they are suggesting reconstruction though the surgeon and the oncologist may have different thoughts on this. Oncologist was worried about the need for future treatment and the reconstruction being "in the way" also the amount of stress it will add to my body as the liver is still in pretty poor shape. Any thoughts or directions to sites that might help me would be greatly appreciated. This is a very hard choice. ( my husband has had colon cancer twice, but his plan of action was always pretty straight forward, FYI he is doing very well...20 yrs since his first and 7 yrs. since his second) I had know idea there was so much not known about Breast cancer and which path works best. Thanks in advance for any thoughts you can share.

[Becky]

For you, or anyone for that matter, it is if there will be a good cosmetic result when you are done. If they have to take half your breast if having a lumpectomy, it will be difficult for you and you will probably have to stuff your bra with tissues for the breasts to match. If this is the case, masectomy would be a better option. If you didn't get reconstruction, you would at least have a prostetic that will match the remaining breast. So, your question can only be answered by your surgical team and how much breast has to be removed in order to remove all the cancer. And after doing so, what amount of breast will be left.

[Jackie07]

Ann Surg. 2012 Jun;255(6):1151-7. doi: 10.1097/SLA.0b013e31824f9769.
Evaluating the feasibility of extended partial mastectomy and immediate reduction mammoplasty reconstruction as an alternative to mastectomy.

Chang EI, Peled AW, Foster RD, Lin C, Zeidler KR, Ewing CA, Alvarado M, Hwang ES, Esserman LJ.
Source

Division of Plastic and Reconstructive Surgery, Department of Surgery, University of California, San Francisco, CA, USA.

Abstract

OBJECTIVES:

To assess the efficacy of using concurrent partial mastectomy and reduction mammoplasty for resection of a wide range of tumor sizes and compare oncologic outcomes and postoperative complications on the basis of tumor size.
BACKGROUND:

Although tumor size greater than 4 cm has been considered an indication for undergoing a mastectomy, this dictum may not apply in women with breast hypertrophy, where the ratio of tumor size to breast size may still permit breast conservation. We wished to evaluate whether an approach combining partial mastectomy with reduction mammoplasty could provide a safe oncologic procedure with immediate breast reconstruction that could technically be applied even for large (>4 cm) lesions.
METHODS:

A retrospective review of all patients undergoing partial mastectomy and concurrent reduction mammoplasty performed at our institution from 2000 to 2009. Clinical characteristics at presentation, pathologic data, and follow-up data were collected and analyzed.
RESULTS:

Eighty-five consecutive simultaneous partial mastectomy/reduction mammoplasty procedures were performed in 79 patients. Average tumor size was 2.8 cm for ductal carcinoma in situ (0.05-17.0 cm), 2.4 cm for invasive ductal carcinoma (IDC) (0.2-8.9 cm), 3.5 cm for lobular carcinoma (1.6-8.0 cm), and 5.7 cm for phyllodes tumors (3.7-7.6 cm). Twenty-five of 85 tumors (29.4%) were larger than 4 cm. Distribution for stage 0, I, II, III, and IV disease was 15, 12, 35, 19, and 2 tumors respectively, with an additional 2 phyllodes tumors. Median follow-up was 39 months (10-130 months). Seventy-five patients (94.9%) achieved successful breast conservation, whereas 4 patients (5.1%) went on to completion mastectomy. Thirteen patients (16.4%) required 1 reexcision to achieve clear margins, and 2 (2.5%) required multiple reexcisions. Two patients had a local recurrence during the follow-up period, one of whom underwent reexcision and the other underwent mastectomy. The overall complication rate was 14.1%, which included 4 major complications (4.7%) requiring an unplanned return to the operating room and need for hospital readmission, and 8 minor wound-related complications (9.4%). Neither recurrence nor complication rates were increased in patients with tumors greater than 4 cm when compared with tumors less than or equal to 4 cm.
CONCLUSIONS:

A partial mastectomy with concurrent reduction mammoplasty technique is a viable option for breast conservation even for larger tumors, combining a safe oncologic procedure with excellent cosmesis. A combined effort between breast surgeons and reconstructive surgeons has a high probability of success with low recurrence rates. In carefully selected patients, this approach may be preferable to mastecomy and breast reconstruction, particularly when postmastectomy radiation therapy is anticipated.

[linn65]

If it was your daughter or sister what would you tell her??? I was unable to do my reconstruction right away because just finishing chemo and 3 weeks later doing the masectomy they felt it would be too hard for my body to go thru all at once. Personally, I would do the masectomy and not worry about trying to match 1 breast and the other making it whole...Now, that I only have 1 breast I can not wait to remove the other one when I have reconstruction done, so I don't need to worry about them matching. At first I was like I don't know if I want the other breast off but now that I am going through trying to match the real one with a prosthetic it is a pain, so I rather just have two fake ones! I am like you I had no idea that Breast cancer was so complicated but it sure is!!!

[Lauriesh]

From a stage 4 perspective, I would be concerned about how the surgery could affect future treatment . After the mast, you would have to wait at least 6 weeks to start chemo again. It could be longer if there are any complications. If your liver got worse during this time, what options would you have.
I think I would take the advice of your onc.


Laurie

[tricia keegan]

I'm not stage iv but did have a lumpectomy and have a small half prosthesis which tucks in to my bra and both breasts now look identical so for me, I'd say go with the lumpectomy and I have had no regrets. Try googling Dr Susan Love where you may get more info on this issue.

[Joanne S]

It's definitely a difficult personal decision- lumpectomy, mastectomy or double mastectomy? All the responses above provide great suggestions.

Six weeks after I completed my treatments, I had a double mastectomy. I didn't want one side to be different than the other side; additionally, I didn't want to have future concerns or worries about breast lumps, mammograms, etc. --- lumpectomy was not an option I even considered--- but that's just me. I felt that if I only had 1/2 or one breast removed, I wouldn't have the option to go bra-less, and did not want to go bra-less lopsided. I have prosthetic boobs and mastectomy bras, but I never wear them as they are very uncomfortable for me (special occassions only). However, many other women that have them are quite comfortable and don't have any issues.

As mentioned above by Laurie, I would focus and make getting chemo and all the necessary treatments done first before having surgery.

Allow yourself plenty of time to educate yourself on all the available surgical and reconstruction options so you can make the best decision option for you.

Wishing you the best in the treatment, Joanne