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You didn't say the locations of the two tumors. If they are connected or close to one another, they should really be considered as one tumor. Of course, the added dimension will put you at the next size group for staging purpose. Also, the surgeon would not likely recommend lumpectomy if the two tumors are not in the same quadrant. Not only the reconstruction will be difficult, but the clean margin can be a serious problem. Therefore, your decision should be made from the actually geography of the two tumors. As to the peace of mind, it is a real issue to consider. The biopsy track will likely cause some degree of spread, particularly if you have long time between biopsy and surgery. In this case, mastec would provide a better choice for reducing the chance of micro spread. Another pertinent issue is that we probably should assume more smaller cancer cells, not detectable by ultrasound or mammography, in the same breast, since you already have two detectable tumors. When you total all factors up, your safe course is likely to be mastec. If you get no node problem and clear margin, you don't need to do radiation. In general, radiation kills most of the residual stray micro cancer cells but never all in the lumptec patients. This is due to the physical limitations the radiation equipment can place on the aft-operation breast, for the geometric as well as heart-protection reasons. Of course, every case is indeed different and you alone should make the decision. Being HER2 positive, you are a candidate for Herceptin, probably with chemo; your prognosis should be quite good.
Good luck and keep us informed.
Ann
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