Surgeon missed the margins. 2nd surgery

Posted by freebird67 @freebird67, Apr 1 6:16am

Good morning all,
Had lumpectomy 3-18 went back on 3-28 thinking surgeon would release me to oncologist but No ! She told me they missed the margins. I was kinda dumbfounded at first, she explained to me that they have to go back in and cut more and scrap. Then asked me.... do you have a problem with this ? Of course I have a problem with this, who wouldn't ! She just told me cancer cells were pushing on the margin. So I'm headed for another surgery this Friday.
I'm loosing faith in the medical system fast. The nurse came in to schedule my surgery and said it happens like no big deal.
So I guess my question is, have any of you gone through this ? Did it change anything for you ? I did do some research about it and didn't like what I read. But have no choice on this. Thank you and
Have a blessed day

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@lislordav

Hello, Just seeing this post. Not very good navigating this website. I met with radiation onco and also got 2nd opinion. they both said the risk out weigh the benefits so I chose not to do it. Now at my 6 month MRI check up I have a suspicious lymph node in right armpit. That was the grade 3 DCIS side. They did ultra sound and have a biopsy for that scheduled in Oct. I am beside myself with worry now thinking they missed something.
Thank you for checking in.. I don't know what to do or expect now.

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@lislordav
Hang in there. The waiting game is soooo hard. Prayers for a good outcome.

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@freebird67

Thank you . I think it was shock. Was not expecting it all.
I was upset mostly because I wasn't told this could happen.
Communication could be better.
Have a blessed day 🙂

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I am so sorry you were not told. My surgeon explained the risk to me thoroughly in our preoperative meeting. Mercifully, I did not have to undergo a second surgery. But I had been prepared for it from the beginning.

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@nora305

I am so sorry you were not told. My surgeon explained the risk to me thoroughly in our preoperative meeting. Mercifully, I did not have to undergo a second surgery. But I had been prepared for it from the beginning.

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@nora305
Did your surgeon explain why they cut it so close? Why not just take a wider margin around the tumor to begin with? I had a positive margin and it happens too often.

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My understanding according to what I was told is that during surgery the tissue that is in the tumor and the one that is healthy look like the same , so they try to cut good margins but sometimes there are some cancer cells around that are not in the images and that are impossible to see during surgery…

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@californiazebra

@nora305
Did your surgeon explain why they cut it so close? Why not just take a wider margin around the tumor to begin with? I had a positive margin and it happens too often.

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Yes, she said it can be very hard for a doctor to gauge the actual size of a tumor and the surrounding affected tissues while you are in the middle of surgery. So a doctor can miss the margins. I told her at pre-op that I had no vanity any more and for her to plan to take as much tissue as she wanted during surgery. I guess she followed my advice!

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@nora305

I am so sorry you were not told. My surgeon explained the risk to me thoroughly in our preoperative meeting. Mercifully, I did not have to undergo a second surgery. But I had been prepared for it from the beginning.

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1 in 4 lumpectomies have to be redone because the surgeons don’t get clear margins. They only take 1-2mm of tissue around the suspected tumor site…about the thickness of a piece of dry spaghetti. You can tell them to take an extra wide margin to better ensure all the malignant tissue is taken. They won’t do it without you telling them too. I’m thinking the lack of margin is all about repeat business.

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@angiemal

My understanding according to what I was told is that during surgery the tissue that is in the tumor and the one that is healthy look like the same , so they try to cut good margins but sometimes there are some cancer cells around that are not in the images and that are impossible to see during surgery…

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The surgeons simply don’t take enough tissue. It is estimated that 1 in 4 lumpectomies have to be redone because malignant cells are left behind.

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It seems ridiculous to cut it that close when cancer is life-threatening. Is another 2-3 mm really going to be a big cosmetic issue? I had a positive margin in the pectoral muscle when I had recurrent breast cancer resected from my chest wall (post-mastectomy). The surgeon acted like it was no big deal and decided not to do a second surgery. She said, “Let’s just let the radiation treatments get it.” I was disheartened but didn’t argue because I was already tired of it all, don’t do well with anesthesia, can’t take pain meds, would need more time off work. I really didn’t want to do it all again. I’m sure you all know what I’m talking about. But I was wondering if this was a good plan. If radiation was that reliable we wouldn’t need to remove the tumor at all — just radiate it. Now the cancer that was left was too small to see on a CT scan so we have no way of knowing if radiation got it. It’s just a wait and see. Unsettling. Then to make it worse, 4 of my 9 boost radiation treatments were off target (another story). I was told, don’t worry you had 5 boost treatments in addition to 27 regular. Well if they felt 5 was enough, they wouldn’t have scheduled 9. I always wondered if the surgeon didn’t want to go back in because a second surgery would damage her record. Hmmm. If I had surgery again, I would ask the surgeon what percentage of their cancer resections resulted in a positive margin and definitely discuss their margin plan.

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@vkroger

1 in 4 lumpectomies have to be redone because the surgeons don’t get clear margins. They only take 1-2mm of tissue around the suspected tumor site…about the thickness of a piece of dry spaghetti. You can tell them to take an extra wide margin to better ensure all the malignant tissue is taken. They won’t do it without you telling them too. I’m thinking the lack of margin is all about repeat business.

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Oh this is disturbing. I had a double mastectomy (cancer was only ever found in left breast and subsequently, left arm pit '17 ( no one took me seriously when I said " what's this hard lump(self exam)in my arm pit '16...finally removed in '19. '21 Moved & changed BC Center/Drs. to my surprise, reccurrence in relative area of left arm pit '22 (I found it in self exam) and now left L5 vertabrae had lesion '23.
So I will not ramble, but it is evident that in a lumpectomy, ASK for as large margins as possible.
A double mastectomy among other treatment issues , subsequent surgeries, did not stop this mysterious and insidious BC. Hanging in there for 10 yrs now.....

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@einnoc

"I'm losing faith in the medical system fast. The nurse came in to schedule my surgery and said it happens like no big deal."
"I was upset mostly because I wasn't told this could happen.
Communication could be better."
"Then asked me.... do you have a problem with this ? Of course I have a problem with this, who wouldn't !"
"You have to be your own advocate."
*******
The quotes above resonate(d) with me. I have lost so much faith in the medical system. I grew up at a time when doctors made house calls. I believed that doctors had a "higher calling" than just collecting $ for office visits. I thought that they cared whether you lived or died, and they would not intentionally withhold information from you that you needed to know in order to be prepared for the worst, if, God forbid, it happened. I didn't expect that an oncologist would employ a bevy of P.A.'s ("the minions," I all them) whose entire job seemed to be keeping you from ever having a face-to-face discussion with The Man and giving you the message, over and over and over, for 17 months, that "the patient portal is not the appropriate forum for this question. You should wait until you have a face-to-face meeting with the ocologist," which, of course, they were probably instructed to make sure it did not happen. I was only seen by my oncologist in Illinois 2 times in 8 months, and, during those brief visits, he never answered the questions I had nor told the truth. I asked about an oncotype and his curt response (Dec. 2021) was "You don't need one." That remark, alone, is debatable in light of the fact that, when I finally got one from my 3rd oncologist in 2023, it was 29. When I asked about the side effects of Anastrozole, his response (in writing, since he never saw me in person if he could avoid it) was, "The only side effect of taking Anastrozole is a little stiffness in your hands and fingers first thing in the morning, and it goes away when you quit taking it." (Wrong!) I also question not giving the patient a chance to recover from a seroma, less than a week out of surgery, before putting them on Anastrozole, and having them take it throughout the 33 radiation treatments. Even the 33 radiation treatments, in retrospect, are questionable, since the University of Iowa Hospitals and Clinics told me, 3 days before I was to start the radiation, that they would not have radiated me at all, because, he said, "You're a woman in your 70s." (basically an age that they seem to feel is 1 foot in the grave.) (Try to maintain you are only 69 at the oldest, because, after that, it is questionable whether or not you'll be viewed as a viable patient with some life left in you. The "be your own advocate" is the most telling, because I have had to be. Today's medical mantra seems to be YOYO: "You're On Your Own."

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Yes I agree the medical systems seem like they treat people as if we’re automated and on a conveyer belt like cattle. Every now and then you get lucky and there is someone nice. However your cut short at appointments, doctors don’t like answering questions, they make so many typos and administrative errors on your records. I think they should release the darn cure. Breast Cancer is growing and Big big money 💰.

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