Masectomy vs Lumpectomy

[tousled1]

I was diagnosed with advanced Stage III breast cancer HER2 positive estrogen/progesterine negative. Two tumors in right breast 2.5cm and 2.1cm. Also lymph nodes tested positive. I am going through neoadjunct chemotherapy now. Next week will be half way through. Next cycle will be with taxtore. After chemo is completed I will have surgery. Sister had DCIS, first cousin invasive ductual cancer, aunt invasive ductual cancer. I have had 2 lumps - one on each breast removed in previous years no cancer. Have fibrocystic disease of breasts. Would like to know individual experiences - masectomy vs lumpectomy. Thanks.

[lu ann]

If I had to do it today, knowing what I know now, I would have bi-lateral mast. I had my surgery 14 1/2 years ago. Since then I have had multiple abnormal mamograms, ultra-sounds, and 2 benign biopsies of the healthy breast. I too have very fibrosystic breasts, which cause much unneeded anxiety.

I had mast. with tramflap reconstructive surgery(tissue from below belly button is used). I'm sure they have fine tuned the process since I had my surgery, Nov. 1, 1991. I had 3 revisions since my origional surgery. They used more tissue then needed so they could go back and use liposuction to shape the breast. I also had the healthy breast lifted and the areola made smaller(I nursed 2 of my children). I waited a year to get the first revision, where they did the lipo and fine tuned the healthy breast. Six months later I had the nipple done. They did not transplant tissue from another area in my body. The plastic surgeon made a few cuts at the end of my new breast and created a nipple. I then went in and had the nipple tatood the same color as my healthy nipple.

I have mixed feelings about this surgery. I'll give the positives first.

I can go without a bra as my breasts are perky.I feel balanced. Mentally I think I did better then if I had opted out of reconstruction. I got a tummy tuck in the process.

I have much nerve damage from the surgery as they cut the tranverse abdominal muscle and nerves. The post-op recovery took a long time. I could not stand up straight or lay down flat. I was horrified post-op at the immediate results. I think the reconsructed breast could have masked the reccurrance.

In your situation I think you could go either way. They will be treating you systemically any way and might be able to clean up cells within the breast after your lumpectiomy. I wasn't a candidate for lumpectomy because they could not get clean margins free of cancer cells.

Take care and feel free to ask as many questions as you need. We all learn from each other.

God Bless You.
Lu Ann.

[Alice]

In my case I opted for the mastectomy. When I was first diagnosed there were 2 tumors visible on the mamo and ultra sound.When I had an MRI it showed another tumor on th other side of the same breast. I had neoadjuvant chemo as you are having. After the chemo had started to shrink the tumors it revealed that one of the tumors was in fact 2 tumors so close in proximity that they were undistinguishable until they started to shrink.
Having so many tumors and them being spread out as they were would have made lumpectomy very dificult and being small breasted to begin with results would be bad.I also would be in constant fear of local reccurance.
Every case is different and how you feel about it is an important part of it.

I think the best thing you are doing is to have the neoadj. chemo.When I had it I couldnt find anyone that had had it and I was forever questioning my decision. Now as I look back a friend of mine has gone thru cancer at the same time as me only she had the mast. before the chemo. When we are both done with treatment I can say with certanty that the chemo worked and she can not as she has no proof of tumor shrinkage due to the mass being removed before chemo.
Good luck, Alice

[Esther]

Four years ago I had a bilateral with immediate reconstruction with expanders. While I am pleased with the results, in looking back, if I had it to do over again, I would go with a lumpectomy instead.

I made the decision out of fear, even knowing that the bilateral did nothing to prevent mets, just prevented another primary.

It's a personal decision, either way.

[Alice]

Hi again,

I forgot to ask if you are going to have herceptin at the same time as taxotere?
If not ask your onc why not. The chemo I had was A/C dose dense x 4 carboplatin,herceptin,taxol x3. I know the carboplatin isn't aproved for stage 3 yet, I had it being in a study. But I'm pretty sure herceptin with taxotere is.
Take care, Alice

This is a recent post that is on essentially the same subject.

http://www.her2support.org/vbulletin...ad.php?t=22740

I included some links on the risks of Contralateral occurence and survival for BCT and masectomy.

I also included some links as to surgical impact risks etc.

Whilst looking for material on fats and BC I saw a "serious" book on breast cancer treatment and reconstruction options and risks. I forgot to look at the publication date, but there might be an upgrade anyway.

"A Womans Decsion"
Breast Care Treatment and Reconstruction"by Karen Berger and John Bostwick 111.


RB

[tousled1]

I will next have 4 treatments of taxotere - once every 3 weeks. I have one more cycle of adriamycin and cytoxan. I am going to have the herceptin treatment alone -- after the surgery. I will have it for 52 weeks. My major problem now is my blood counts -- they drop so low. I get neulasta the day after chemo and procrit once a week. I'm suffering from sever fatigue but I guess I shouldn't complain since I have no nauseau. My doctor believes that a lumpectomy should be just effective as a masectomy but I am personally leaning toward a double masectomy. I have large, very dense breasts and had my mammograms every year. I discovered the lump and last year nothng showed up on the mammogram.

[Cynthia]

My heart goes out to you; we have all been where you are now. Like you, I had very dense breast tissue. Even after my lump was diagnosed via a biopsy (2cm just under my skin right there for the feeling), a subsequent mammogram still couldn't pick it up. I too had fibroid cystic disease, so there were lumps everywhere. While I heard the statistics about there being no difference in survival between lumpectomy and mastectomy patients, so little was said about the heartbreak of having to go through everything a second time should a new primary appear. Thus, recognizing that there was no right or wrong decision to be made, I did what I felt was best, and that was to do a bilateral mastectomy with immediate reconstruction via expanders. I had my initially surgery in 9/03, and I just recently finished the whole process (i.e., my nipples are done and my tattoos are dry). If it weren't for the faded scars running across each breast, no one would know that they are completely man made. I love having them (though all sensation is gone which is too bad but not horrible in the scheme of things). My husband really could have cared less what I did -- he is a wise man -- he just said he wanted me to live long and be happy. I like looking in the mirror and feeling sort of like me again (albeit with much more perfect breasts than ever before). Aside from the vanity stuff (for which I do not apologize), I feel like the procedure bought me some peace of mind in that I don't have to fret over each lump and bump that would have remained in my "good" breast had I not taken it off.

What you will see as people respond to you is that we have all made such different choices, though each of us seems quite content with the choice we made. I wish you the very best as you figure out what will work best for you.

Cynthia

[Ginagce]

I'm sorry you have to make this decision. It is indeed a tough one. Rather than repeat what has already been said, I will just add my two cents.

I chose bilateral mastectomies with immediate DIEP reconstruction. This surgery is similar to the transflap but no stomach muscles are used so you are not subjected to the side effects of cutting into stomach muscles. There are of course always issues with any surgery, but with DIEP, this is not one of them. For me that was important as I am a very young 50 and have always been quite active.

I am one year plus a little out from my mast/recon and I am satisfied that I made the right decision for me. In my case, when they did the masts, they found another tumor in the "unaffected breast" that had not shown up on the mammogram or with the ultrasounds I had. For me my decision turned out to be a life saver but I do understand that my case is unusual.

If you're not familiar with DIEP surgery, there are some websites that I can dig up for you, just let me know.

Best wishes in your process.

Ginagce

[tousled1]

I want to thank everyone for their replies. I know this will be the hardest decision I make in my treatment and your input really does help. I've seen a plastic surgeon and was told that I don't have enough fat to do tramflap reconstruction but would have to have spacers. I expect to have surgery in early June and will definitely be keeping up with the postings on this website. It's great to know that I'm not alone and that anytime I need someone to talk to it's only a click away.

[michele u]

it sounds like i'm the exception here. I had stage 3 and 35 pos. nodes. My surgeon stronger suggested to just have the lumpectomy. He said that there are so many surgeons doing the mastectomies and not giving the option. He told me then that the lumpectomy and radiation was just as effective. I haven't looked at the stats lately about the difference. I did think about having them both off now, being 2 1/2 years out, but i don't want to stress that arm anymore fearing lymphedema. I dont know what the answer is?

[lu ann]

I really don't think there is a right or wrong answer to this. Just like there are many kinds of breast cancers, there are many different treatments. We just have to go with how we feel about this from the depths of our soul. I know I would have felt like a freak if I did not get the surgery done when I did. I remember the way my mom looked when she had a radical mastectomy where they also take the muscle underneath the breast. I could count all her ribs. She even had her ovaries removed, but no chemo. She died 13 years later with mets to her spine from the either breast cancer or colon cancer. Blessings. Lu Ann.

[CherylS]

Here is a newly released article on the subject that I found just this morning. Hope it is helpful. I had bi-lateral mas. with implant reconstruction and am glad I did.

http://www.komen.org/intradoc-cgi/id...Secondary=true

This article needs reading very carefully.

The figures quoted

"172 (5%) of the women developed an isolated local or regional recurrence.

1182 (33%) of the women experienced another event (distant metastasis, death, or non-isolated local or regional recurrence)."

come from the WHOLE population of 3062, and so does not tell you very much, (except being rather depressing) and I did not see any reference to time frame.

I also do not understand the following comment in the light of a claim of an 80% increase. I presume the first line refers to the outecome of younger v older patients - an accepted fact younger women fare worse, and the second suggests that the type of surgery Masectomey v BCT I guess made no difference.

"Compared to women who were over the age of 50 at the time of diagnosis, women age 35 or younger had a more than two-fold increase in risk of isolated local or regional recurrence.

Young age was also linked with an increased risk of distant metastases, death, or non-isolated local or regional recurrence. Type of surgery, however, was not linked with these outcomes."

DEFINATELY and example of an article that is a best unclear. My first reading was that the tome was masectomy much better than BCT but closer reading suggests that the findings may well be in line with other trials which conclude not a lot of difference.

RB

Errata total population was 3602 and not 3062, but that dose not alter generla questions as to direction of the article.

RB

I have been asking myself if I over reacted to the article above. On reflect maybe, but it could maybe have been clearer.

It is clearly a complex issue, and there can be very good individual reason for the choice.

However the issue has also been raised as to whether there is a link between economic circumstances and masectomy as an option. I read this link a while ago.

Does deprivation affect breast cancer management?

http://www.nature.com/bjc/journal/v9.../6602390a.html

ABSTRACT

We evaluated whether social deprivation affected decision-making for breast cancer surgery. Of 3419 patients, 53.6% had mastectomy and this was predicted by deprivation, age, tumour size and hospital, all of which retained significance on multivariate analysis, except deprivation. Pathological characteristics and surgical decision-making determined choice of operation not deprivation.

Keywords: social deprivation; breast carcinoma; surgical decision-making



Awareness of health inequalities between rich and poor has never been greater. The recent publication of health and life expectancy data in Scotland has shown that the gap between rich and poor in Glasgow persists (Clark et al, 2004). These inequalities are also seen in women with breast cancer. Survival differences between women from affluent areas and women from deprived areas are around 6% in England and Wales (Coleman et al, 2004) and 10% in Scotland (Thomson et al, 2001). Part of this difference is explained by more oestrogen receptor (ER) negative tumours in deprived women, but no other pathological differences have been observed (Thomson et al, 2001). Several other studies have looked at other pathological criteria as the reason for the persistent survival differences and they have all failed to demonstrate an association (Carnon et al, 1994; Macleod et al, 2000a; Brewster et al, 2001). Access to health services does not appear to be a factor; in fact, deprived women appear to use primary care resources more often than the more affluent (Macleod et al, 2000b). Despite this, the question remains whether deprived women are treated differently in secondary care.

Trials have shown no survival advantage from mastectomy over breast conservation surgery for tumours up to 5 cm (Fisher et al, 2002). The contraindications to conservation are well documented: multifocal tumours; 1st or 2nd trimester of pregnancy; history of previous irradiation to the affected breast; or a large tumour in a small breast that would result in an unacceptable cosmetic result.

We have analysed data from the Glasgow Breast Cancer Audit to measure the mastectomy rate. We hypothesised that if the mastectomy rate was higher than expected, this might be a reflection of high levels of deprivation in Glasgow (McLoone, 2004). Additionally, if surgeons were influencing women in choice of surgical management, were they actively suggesting conservation for affluent women?