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Hi again.
I think this is a grey area, how to proceed with surgery after neo chemo. Many surgeons have no experience with this -- and the ones that do will admit that it's unpredictable. I had neo chemo, and then a lumpectomy. My surgeon said that he can't tell how the tumor has disolved until he gets in there (it can completely disolve, disappear from the outside in (literally get smaller) or leave scattered pieces.
The doc won't know for certain how well the chemo has worked until he/she gets in there, and then the surgical pathology is completed. In my opinion, this is the surgeon's call, and so you want the most experienced, progressive surgeon you can find. You want someone who only does breast surgery, believes in breast conservation and does bc surgery so often that he's seen everything.
So, find that surgeon! (I know one in LA, but that's pretty far for you) Frankly discuss your preferences before surgery, and then leave it in his/her hands -- since the surgeon is the only one who will really be looking at the tissue, then analyzing the path report. A good surgeon will also be sensitive to and talented at cosmetic outcome -- so a lumpectomy will only be done if the outcome will be physically and psychologically positive.
Let me know if you need more info.
Best
Linda
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