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Mastectomy vs. Lumpectomy
I have been diagnosed with Invasive Ductal c. It is R+, P+, and HER2 -, Ki67 is 23% and Grade 3. (Nottingham score?). It is Stage 1 because the tumor is small- 1 cm. Oncologist feels all is needed is lumpectomy, but of course gave me options of lumpectomy, mast. And bilateral. Lymph nodes look ok in scans but won’t know till surgical pathology. I went to a natural osteopath for a second opinion and he was fine with lumpectomy, but when I asked what he’d do if it was his wife, he said double mast, because of the type of cancer and proliferation rate- which is in the high range. Oncologists are thinking there will be no radiation or chemo needed, but of course post surgical pathology on lymph nodes is needed. Then followed by aromatase med. I have had several people- medical and BC survivors recommend go ahead with double mast. What are your thoughts and experiences? I am a larger breasted 44c-d gal and don’t like the option of only one mastectomy so it’s either lumpectomy or both in my mind.
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One more thought…I’m 67. Certainly comfortable with no breasts and occasional use of prosthesis, so I’d go flat.
@grannyb I had a ki67% of 19, just over the line in 2015 (yours isn't too high). Here is an article on ki67% https://pmc.ncbi.nlm.nih.gov/articles/PMC8487652/ In 2015 my doctors considered it unreliable so some hospital had it, some didn't.
I was also ER+ PR+ HER2- and grade 3 with lymphovascular invasion. BUT a low Oncotype. Even with grade 3 and those other factors. The Oncotype is a test done with your pathology (sometimes with biopsy, preferably after surgery) and includes the ki67% and some other proliferation factors. You can still do an Oncotype with 1-3 lymph nodes positive.
The Oncotype tells you whether you would benefit from chemo and also gives risk with and without aromatase inhibitors.
This is all just fyi. As to your original question, it is a personal choice. Every doctor tells us the risk is the same with either lumpectomy or mastectomy.
I chose two mastectomies (doctors wanted me to try one first due to lupus, to see how I handled it) and wetn flat. I don't actually wear prostheses but lots of people do. The mastectomy on the non-cancer breast showed a lot of cysts but also atypical dysplasia (Possibly pre-cancerous) so I was glad I did it. But plenty of women have lumpectomies and do fine!
I was like you- I didn't want one gone. I was told I had a legal right to symmetry!!
I don’t want to talk you out of a mastectomy but there is another option to consider than just a lumpectomy on one side.
I was a 34DD, 68 yr old. I had right side non-invasive DCIS so my decision was a little different. However, I asked for a lumpectomy with oconoplastic surgery to reshape the right breast, with surgery on the left breast for symmetry.
The law that says they must provide an option for symmetry has no consequence if they don’t do it. So it is more like a guideline. But it sounds like most facilities will do surgery to make both breasts similar.
When the plastic surgeon discussed what was going to be done during the pre-op appointment, I said I’d prefer the end result to be smaller breasts as I’ve never been comfortable with large breasts.
My surgery was listed as a lumpectomy with oconoplastic surgery and mastoplexy on right, and a mastoplexy on left for symmetry. I am now about a C+ cup on each side. I did have 5 days of radiation. It was 30 Gy in 5 hypofractionation to partial breast. With invasive cancer, whole breast hypofractionation is more often done I think. I am on tamoxifen for minimum 5 years.
I don’t know which option is best for you, but just wanted you to know that a breast reduction on both sides might be possible.
@triciaot Rubyslippers brings up another point. My doctors didn't want me to have radiation and I didn't want it either. I was told one in five radiologists would have wanted me to have radiation even with the mastectomy. In general, lumpectomy means radiation and sometimes (often?) mastectomy avoids it.