Surgeon missed the margins. 2nd surgery

I also had lumpectomy at MD Anderson and margin was only 1 mm on one focal point (DCIS). Their recommendation was either having radiation and no second surgery, or surgery to remove more tissue, bigger margin. I was already planning on radiation because of the lower risk number, but I was really unsure about having another surgery on the same area.

My plastic surgeon said in all the time he had being doing this work, the new tissue removed during the second surgery to increase margins had never showed any cancer cells.

My thoughts were - the missed margin was on the anterior (skin) side, which meant thinning the fat layer under the skin making it more susceptible to damage from radiation, and, if they missed the margin the first time what’s the chance that they are going to find that exact piece of breast that needs to be removed the second time?! I don’t blame them for the missed margin, all the tissue looks the same, it’s actually pretty amazing they cut the entire cancer out. But if having a second surgery would probably end up showing it was not needed (no cancer cells in the margin they took out) . . .

So, I did NOT have surgery to increase the margin. I’ll tell you if that was a good decision in, oh about, 5-10 years.

I don't understand why a 2nd surgery would be necessary to clean up a margin that had pre-cancerous cells when radiation can take care of this. Can someone explain this to me?

My Surgeon in FL said it's not necessary to clean up the margins since I'm getting radiation. My Oncologist in Mi said I should meet with a Surgeon to clean up the margins prior to radiation. Both say their advice is the standard of protocol. I'm wondering which is more common.

I had a positive margin in my chest wall (recurrent cancer post mastectomy Ki-67 50% very aggressive) and the surgeon said let’s just let radiation get the rest. No second surgery. That honestly didn’t sound like a good plan to me but I was burned out on all of it, don’t do well with anesthesia, didn’t want another surgery and also had neuroendocrine lung cancer they were waiting to treat next so I went with that recommendation. My thought though was if they are so sure radiation will kill the cancer cells in the positive margin then why do the first surgery to remove the tumor?Why not just let radiation kill all the cancer in the first place? Things just didn’t add up in my mind and I was afraid it was a CYA decision for the surgeon. I had 37 radiation treatments but they missed the target area on the first 4-5 boost treatments (oops) so another error. I was told don’t worry, the other 32 treatments got it. Again, if you think that 32 on target were sufficient then you wouldn’t have scheduled 37. The surgeon and radiation oncologist both lost credibility in my eyes. I’ve been on Kisqali and Letrozole for the breast cancer for 4 years now and so far so good. Like someone else said, only time will tell.

Just an update, I'm a little over a year since I posted about the second surgery. I just had a mammogram and was totally clear. I'm grateful. But I still say it should be protocol for surgeon to tell you it's possible to have to have a second surgery for missed
margins. I was so stressed
With every thing you go through for the first surgery that second one blew my mind. Im doing well now except I can't lay on that side, it just uncomfortable. I guess that's normal. Im on Anastrozole which in the very beginning I didn't want to take. But doing ok on it. It does make my bones hurt especially in the mornings and a liver count scare. But that turned out to be OK. But we all know that only time will tell. I'm hopeful and try very hard to stay positive. Blessing to you all !

I'm glad you are ok, but it's too bad there's so many side effects. I read in a book just yesterday that clean margins are missed 20% of the time. My surgeon did mention this possibility, but it wasn't until I read how common it is, did I feel less resentful about it happening. Did you go through radiation? I didn't realize a side effect of Anastrozole was pain in bones. That stinks. I hope you get stronger in time.

Hi freebird67. I am taking Verzenio with Anastrozole once daily, then Verzenio alone at night. The Anastrozole is an Estrogen blocker so I will be taking a Prolia injection in the next week or so. I fought the Prolia for 2 years but decided I'd take a chance on Prolia, than perhaps end up an invalid with broken hip, etc. that may not heal. My bone density is NOT GOOD. The Anastrozole is necessary to fight the cancer, but horrible for bones. I'm so glad to know that it can cause sore bones. I wasn't told that. I'm doing great on it, thusfar. (Started September 2024). Thank you for the information. Be blessed! Hugs.

Jkcares25, yes I'm doing fairly good. I did have 26 days of radiation, no chemotherapy. I guess you could say I'm old school , when you go to a Dr. They sit down and explain what's wrong, what their plan is to help you,and the risks. But your lucky if you get 10 minutes with them. To have a second surgery less then a week after you had the first was very upsetting to me. And maybe I wouldn't have gotten so up if my mother and a sister hadn't died from breast cancer. I really felt over whelmed. Now I won't let my oncologist out of the room until my question are answered ! Anastrozole does have several side effects, as I said bone pain, hair thinning , vaginal dryness , brain fog and uni's. I have good days and bad ones, but have learned to take one day at a time. Actually today I feel blessed.

Hi anniez1943, it took me a little while to even make myself take the Anastrozole, but finally did after much arguments with my family. The worse time is in the mornings with it,I have learned to take my time but still be active as much as I can.
I too was suppose to start the Prolia, but refused it. I was not ready to start bombing my body with all these meds at once on top of all the other meds I take. I too have osteoporosis , I just needed time. But I am now on Ibandronate that I will take monthly. Im just now starting it, so I'm unsure of side effects yet. Im not familiar with Verzenio, may I ask what that is ?

Hi freebird67. Verzenio is an "expensive" cancer drug. Look at the many many side effects. Too many to explain; however, my oncologist prescribed it over any other chemo-type of treatment. I'm now doing great on it with zero side effects. When my hand surgeon explained to me that I could break my hip (my femur is in bad shape) and lose my independence if a break couldn't be repaired, etc.etc., I'm a very active and busy 82 year old (praise God) and gosh, when he told that to me plus I could be totally bed ridden after a hip break, I decided to try the darn Prolia. I do have a few friends who took it twice a year for 2 years and they had zero symptoms. It's a shame we gals have to worry about all of this in our golden years. We're supposed to be having fun and enjoying life. My best, best wishes to you.