Masectomy vs. Lumpectomy?

skoolmom · 11-05-2005, 01:22 AM

I'm newly diagnosed Oct. 26, I'm ER/PR neg. and Her2 -3t positive, infiltrating ductal type, poorly differentiated. I have two lumps only the bigger one was tested and it measured on the ultra sound 6mm by 7mm. I'm seeing a 2nd surgeon this Tues. I want to schedule surgery with him on Tues. to be done ASAP - I want those babies out of there! What should I do - Lumpectomy or Masectomy- what have most of you done? My mother died 16 yrs. ago of breast cancer and she had a double masectomy. I was thinking that maybe I should get a lumpectomy and do herceptin and hope and pray I'm one of the lucky 52 % that do not have a recurrance. Did everyone who has Her2 - 3t also have to get chemo and radiation? I'm still learning about all of this! I also have a good friend who also has breast cancer except she was er/pr positive and Her2 negative and she's going through chemo right now.

jhandley · 11-05-2005, 03:01 AM

Hi
If I had my time over I would have a mastectomy. I had a lumpdectomy and then recurred 4.5 yr later...different spot in the breast and second time it was not detected by mammo. or ultrasound (25% of lumps in women between 40 and 49 are not) and was 4 cm. I now have a single met to the liver 1.5 cm and wonder if I had insisted on the breast off to start with (which is what I wanted) whether I would be in this situation now.
I know the research shows that either gives the same odds but peace of mind is not factored into that and it means a lot.

regards
Jackie

RhondaH · 11-05-2005, 03:19 AM

I was dx 2/1/05 Stage 1, Grade 3, ER/PR-, Her2+, No nodes. Had partial mastectomy on 2/7/05 (my surgeon cancelled another appt to get me in asap). I asked him to do a double mastectomy, but he told me that he would not recommend it (I had 1, 1.6 cm lump) as though my insurance would cover the affected one, it would not the other and mine wasn't the kind that spreads from breast to breast. One I often think of (and there was a discussion on this a long time ago) is Christine who had a lumpectomy for Stage 1, no nodes in 1990 who had a recurrence in 1998 (I'm not sure of the time frame, but this is approximate) to her brain and has successfully been on Herceptin ever since. I think if I were looking at 2 poorly differentiated and there was a family history of it, I would demand a double mastectomy. I also finished 6 rounds of dose dense TEC (taxotere, epirubicin and cytoxan) on 5/16/05 though the protocol since then has changed to AC (not sure of how many rounds) followed by 12 weekly Taxol/Taxotere w/ Herceptin followed by 40 more weekly (or this can be done every 3 weeks like I am doing) Herceptin alone. Also, I finished 33 rads (28 w/ 5 boosts) on 8/1/05 and began Herceptin every 3 weeks on 8/18/05. Some else said and I truly believe that breast cancer is like Russian Roulette w/ 9 in the chamber and for everything you do to fight it, you can remove a bullet and improve your chances of survival. 1. Prayer 2. Surgery 3. Chemo 4. Radiation 5. Herceptin 6. Diet (drink a TBS of olive oil each day to help w/ the HER2...see other posts on this) 7. Exercise 8. Yoga 9. Meditation. I know when I was first dx, I went to every support group online for answers until I found this one to best suit my needs and don't really visit any others. Good luck and good health.

Rhonda Hoffman

11-05-2005, 06:07 AM

Keep in mind this is just MHO and experience, but in my case I wish I had done the mastectomy first. I had lumpectomy, DCIS comedo type, with 33 rads 9/03. Recurred this year with DCIS and IDC, Her+++, 3 nodes NED, mastectomy with contralateral, started 1st chemo (6 rounds) with Herceptin (1 year) yesterday.

Right after my lumpectomy in 03 a little voice kept telling me I should have opted for mastectomy, no rads and immediate reconstruction which was offered to me at the time. Perhaps I would have still recurred, btu I wish my little voice would have been speaking louder before I made my decision then.

Michelle · 11-05-2005, 10:10 AM

Skoolmom as the above post mentions-hear your inner voice-it is speaking to you. My surgeon did not reccomend mast , but my inner voice did. I was dx in Mar 2005 with 1.9cm, er/pr+, her2+++. I still question if I made the right decision by going with lumpectomy. I pray that I have, but should have went with my inner voice. Will I question my decision if I reoccur? Absolutely, but if not for this reason proably others too.

CLTann · 11-06-2005, 03:26 PM

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

suzan w · 11-06-2005, 05:01 PM

I was dx'd 5/05 with invasive lobular in left breast...decided on bilateral mast. (due to the nature of the lobular beast)...small tumor 7mm, node neg, er/pr+, her2+, no reconstruction. Had bone scan/CT scan-all neg. Then had oncotype dx, which put me at a hige-intermediate risk of recurrence. Did 4 rounds of A/C (chemo) and am now on herceptin, 3 wk. intervals. Also, my onc. wants me to do arimidex (for the er+). I am looking into that as it is supposed to thin bones and I already have osteoporosis...I am 55 yrs old. My "little voice" said 'bilateral mastectomy...' and I have NO regrets!!! Good luck in your decision!!!

chrislmelb · 11-07-2005, 01:58 AM

I had a partial and nodes out as we knew from the start it was in the nodes(from my lump which was a cancerous node) then i had a wide local excision and then i had a mastectomy. My surgeon is into breast preservation so that is why it went that way. My primary site was undetectable by mammo or ultrasound and it was over 2cm. I now feel relieved to have had it all off as there might have been another lump undetectable. And i was relieved not to have to do radiation after my chemo.
As there are two obvious lumps in your breast, i would be tempted to get a mastectomy but of course i am biased. if you are HER-2+++ it tends not to be inherited.
So all the best with your decisions. Surgery, chemo and herceptin i am sure will put you in the 52%
Christine

mts · 11-07-2005, 06:22 AM

I had 2 lumpectomies- ER/PR- and HER2+++; no nodes. The tumors were all in the same quadrant and undetecable under mammo and U.S.
Did chemo and rads...
I pondered almost one month regarding mastectomy vs. lumpectomy. After 4 surgical opinions, all the women docs said mastectomy and the men docs said lumpectomy. My inner voice said lumpectomy... Today, after reading all this stuff about recurrance rates and ER/PR- negative stuff, I would still have the lumpectomy. Scientifically, both procedures are very close in success comparisons. In hte end, follow your inner voice.

Maria

Joe · 11-07-2005, 04:58 PM

The two tumors are seperate but close enough that they would have been taken out anyway in the margins if they wouldn't have seen it in the ultrasound. So now they will do a margin outside of that one. I'm still young only 48 ( young at heart anyways) and I'm single (have a boyfriend but no marriage again in sight) so that's why I was leaning towards the lumptectomy with herceptin of course and the hope and prayer of being one of the 52% with no reoccurance. I'm small chested to begin with. My mother however did have a double mascectomy but that was about 20 years ago. She died from breast cancer 15 yrs. ago. I really wish I would have kept more in tune with what kind she had and had all that info now. She had it in her lymph nodes I do remember and she went through radiation and chemo. Hindsight now! Thank you for responding to me, I'm glad I found the Her2 group I've been tryin to read everything everybody is sayin and tryin to keep on top of this. Thanks again for your help and information.

Skoolmom

chrislmelb · 11-07-2005, 05:41 PM

My mother also died from BC 19 years ago. They did a mastectomy but she only had radiation. it was in one node. She was diagnosed at 52 and dead at 55. Initially it played on my mind(especially since i had 3 nodes affected) but now i hardly think of her in relation to my illness because 20 years is a very long time in medical improvements. they didn't even know about HER-2 then. I have been tested for the genes and i don't have them.
I am 42 and married(don't know for how much longer!!) and have a 6yo daughter. i have found the mastectomy really not that bad because there is so much you can do to make yourself look 'normal' to everyone else. i had an expander inserted at the time of surgery so there was something there when i woke up.
Good luck with your decisions and let us know what the surgeon says.
Christine

Ginagce · 11-11-2005, 05:40 PM

Hello Skoolmom. First let me say that I am sorry that you have joined our ranks. So many hard decisions to make at the most stressful times of your life. Prayers for you.

I chose to have bilateral mastectomies after being told by my oncology team that a lumpectomy and radiation of my right breast would be the best treatment after a sentinel node biopsy showed no spread to nodes.

I had previously (7 years earlier) had been diagnosed with DCIS in left breast and had lump and radiation at that time. I also had LCIS in both breasts.

So when I was diagnosed with an invasive ductal carcinoma in my right breast last summer, I decided I wanted to be as done with this as I could, hence the bilaterals.

When my oncology surgeon did my mastectomies, thankfully, he decided to do a node biopsy on the "good" side as well. Pathology showed that not only did I have a tumor in that breast that had gone undetected, but that I did indeed have lymph node involvement on my left side. I got lucky because I made the choice to have mastectomies rather than treat the right breast only.

At the end of the day, we live by our choices and I believe as others have stated that you will ultimately make the best decision for you. I thank god every day I listened to my voice within and followed my instincts.

My best wishes to you.

Ginagce · 11-11-2005, 05:44 PM

Skoolmom, have you been tested for Brac gene? Perhaps knowing that would help you make a decision. Something to think about/inquire about?

Gina

Val Pfeiffer · 11-13-2005, 06:16 PM

Skoolmom--Have you asked about getting neo-adjuvant chemo before surgery? My tumor shrunk greatly prior to surgery. As soon as you are cut open, the blood vessels to the tumors are severed and chemo & Herceptin can't get in there. I had a similar diagnosis to yours and I am so thankful that I had the neo-adjuvant chemo. If I had waited until after surgery it would have been another four weeks or so with no Herceptin.

I opted for a mastectomy instead of a lumpectomy, but I am smal breasted and had a larger tumor, so I didn't have a choice :-)

I realize everyone is different, but if you want to know more, please contact me.

good luck with your decision :-)
Val

Val Pfeiffer · 11-13-2005, 06:19 PM

Also--my detailed more-than-you-really-want-to-know story is on my journal site:

http://journals.aol.com/valleygirlvn...CancerUpdates/

I apologize for the length of it, but something in there may help you! :-)

athena453 · 11-14-2005, 03:42 PM

Just a bit more advice...

From a young perspective (I was dx 5/2/05 at age 27, 30/34+nodes, her2+, ER/PR-)...

I had a mast on the affected side about a week after dx. My tumor was 8x4x3.5cm so I was never a candidate for a lump. Though I have never regretted the mast, I would have pushed harder for a prophylactic mast on the unaffected side. Though I have not yet had genetic testing (very little family history) I would rather have gone through the surgery. I have a small frame and one large C cup breast, which has caused my whole back to feel strangely "out of whack".

I just finished chemo last week (AC, taxotere+carboplatin) and I will remain on herceptin for at least a year. Unfortunately, it looks like I will have to pursue an SGAP reconstruction years in the future. For what it's worth, I would rather be flat chested at this moment in time.