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Lumpectomy + radiation VS Mastectomy -- pros cons?

Posted by jjmoon @jjmoon, Mar 25 7:41am

Hi,
I was diagnosed with DICS ER- Multifocal in the fall. It has taken four months to get to this point in the process. Right now I am scheduled for surgery (a lumpectomy), after which I should have radiation.

My DCIS covers a larger area so I am right on the line between mastectomy and lumpectomy. I chose this path because it is less invasive. Also I fear the risk of lymphedema (rational or not, that is something I grapple with).

My question for this fine group is the following:
If my margins are not clear OR they find invasive OR I have a local reoccurrence -- I will have to have a mastectomy. The plastic surgeon (who will close me up and try to make things look good) has suggested I consider going straight to mastectomy because in their words "Radiation is horrible".
The radiation oncologist said something different -- more along the lines of "there are minor side effects but they are temporary".

So, I am curious if others have faced similar?

Just to be clear, my questions are around side effects of radiation vs bigger surgery/longer recovery/risk of lymphedema (sentinel node biopsy, not dissection)

Thank you in advance!
jjmoon

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Profile picture for alisa1
alisa1 | @alisa1 | Sep 8 3:03pm
In reply to @jjjw "May I ask how old you are? I am 67 and have been thinking about double..." + (show)
Profile picture for jjjw @jjjw

May I ask how old you are? I am 67 and have been thinking about double mastectomy instead of the lumpectomy with radiation and 5 years of hormone suppression. Thank you for sharing.

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Hello @jjjw. I was diagnosed at 50 and had the surgery at 51. My boss is late 50s and chose the lumpectomy with radiation. She preferred that and was pleased with her results. However, my surgeon said that the recurrence rate was higher with a lumpectomy.
I think it is up to the individual and you do what is best for you. However, I am totally pleased with the double mastectomy and opted out of chemo. No medication was required in my case.
Best to you on your journey.

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jknows | @jknows | Sep 12 11:11am

I had a single mastectomy and reconstruction. I was hell bent on avoiding radiation. Sometimes it is easy, but when it isn’t it can be horrific. My PS said that the RO “undersell” it and make it seem easy. But your tissue is never the same!
My PS will not due immediate expander placement if you have to have radiation, he wants it completed and fully healed before reconstruction begins. This is because the tissue is never the same after radiation and he does not want to have his work altered by the changing tissue.
Avoid radiation, if possible!

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hq25 | @hq25 | Dec 17 1:51pm
In reply to @laurieak "I had a double mastectomy and reconstruction eight years ago. At. first the surgeon discouraged me..." + (show)
Profile picture for laurieak @laurieak

I had a double mastectomy and reconstruction eight years ago. At. first the surgeon discouraged me from removing a healthy breast,but supported my decision. I tend to have side effects from many medications. Have not had any complications. Only took extra strength Tylenol for pain post surgery. Have never regretted my decision.

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@laurieak This is good to hear. I was diagnosed with Stage 0 in one breast about a month ago- but it's in multiple areas so I was offered either an attempt for lumpectomy and radiation or mastectomy, which will be in Jan. I'm 42 and healthy so the diagnosis was a shock and weighing the decision has been really hard and also surreal. That said, I'm really surprised that I'm strongly leaning toward double mastectomy- firstly because I want to reduce my risk of recurrence and also because I really don't want radiation. It's so helpful to come on here and read people's stories and also to hear you say that you don't regret your choice. Happy for you and thank you.

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3 replies
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laurieak | @laurieak | Dec 17 2:26pm
In reply to @hq25 "@laurieak This is good to hear. I was diagnosed with Stage 0 in one breast about..." + (show)
Profile picture for hq25 @hq25

@laurieak This is good to hear. I was diagnosed with Stage 0 in one breast about a month ago- but it's in multiple areas so I was offered either an attempt for lumpectomy and radiation or mastectomy, which will be in Jan. I'm 42 and healthy so the diagnosis was a shock and weighing the decision has been really hard and also surreal. That said, I'm really surprised that I'm strongly leaning toward double mastectomy- firstly because I want to reduce my risk of recurrence and also because I really don't want radiation. It's so helpful to come on here and read people's stories and also to hear you say that you don't regret your choice. Happy for you and thank you.

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@hq25 Good luck to you! That is exactly why I made that decision eight years ago.

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hq25 | @hq25 | Dec 17 3:33pm
In reply to @laurieak "@hq25 Good luck to you! That is exactly why I made that decision eight years ago." + (show)
Profile picture for laurieak @laurieak

@hq25 Good luck to you! That is exactly why I made that decision eight years ago.

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@laurieak Thank you! I'll take all the love and good vibes I can right now. 🙂

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jawold | @jawold | Dec 18 8:25am
In reply to @hq25 "@laurieak This is good to hear. I was diagnosed with Stage 0 in one breast about..." + (show)
Profile picture for hq25 @hq25

@laurieak This is good to hear. I was diagnosed with Stage 0 in one breast about a month ago- but it's in multiple areas so I was offered either an attempt for lumpectomy and radiation or mastectomy, which will be in Jan. I'm 42 and healthy so the diagnosis was a shock and weighing the decision has been really hard and also surreal. That said, I'm really surprised that I'm strongly leaning toward double mastectomy- firstly because I want to reduce my risk of recurrence and also because I really don't want radiation. It's so helpful to come on here and read people's stories and also to hear you say that you don't regret your choice. Happy for you and thank you.

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@hq25
I was in the same boat last April. I chose the double mastectomy and I feel like I did the right thing. I avoided radiation and tomoxifen. The waiting before surgery (2months) was the hardest part. Always questioning my decision. Surgery was not as hard as I thought it would be. Did get seromas. Piece of mind is what I got. Best wishes for you and your journey

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2 replies
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jjjw | @jjjw | Dec 18 10:24am
In reply to @jjjw "That is frightening. Would you be willing to share whether this was a Mayo doctor? I’m..." + (show)
Profile picture for jjjw @jjjw

That is frightening. Would you be willing to share whether this was a Mayo doctor? I’m afraid I will be told “no”. I am rather shocked that they would not consider the mastectomy if so desired. I am also 67 and expected to live until well into my 90’s before this diagnosis. Thank you for sharing.

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@jjjw you sound exactly like me. I was so healthy and headed from a long life. Yes it was a Mayo doctor, but I stuck to my guns and they worked kindly with me and I finally had the double mastectomy, thank God. My right breast, which they thought had no cancer in. It was removed and they found cancer in it. That was too small to be seen on the mammogram. I hope you recover well and thrive. I’m excited with my new breasts.

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jjjw | @jjjw | Dec 18 10:26am
In reply to @alisa1 "Hello. DCIS right breast thriver here! I chose to do a double mastectomy with reconstruction! It..." + (show)
Profile picture for alisa1 @alisa1

Hello.
DCIS right breast thriver here! I chose to do a double mastectomy with reconstruction! It was the best thing I could have chosen to do.
I did the mastectomy and had expanders placed on the same day. Surgery time was longer but recovered well! It was the filling of the expanders (stretching of the skin) weekly or biweekly that was somewhat grueling but well worth it.
My surgeon did not recommend lumpectomy due to radiation side effects. However, 4 rounds of chemo was the recommended treatment plan post-mastectomy.
Having been diagnosed with "C" was not easy but, I had a positive experience with my medical care and treatment. I was glad I took this pathway towards healing, recovery, and thriving.

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@alisa1 thank you for sharing. I had the expanders right away, but they were put under the muscle. It was a painful recovery but well worth it. I am happy with my new look. Best wishes to you.

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hq25 | @hq25 | Dec 18 11:50am
In reply to @jawold "@hq25 I was in the same boat last April. I chose the double mastectomy and I..." + (show)
Profile picture for jawold @jawold

@hq25
I was in the same boat last April. I chose the double mastectomy and I feel like I did the right thing. I avoided radiation and tomoxifen. The waiting before surgery (2months) was the hardest part. Always questioning my decision. Surgery was not as hard as I thought it would be. Did get seromas. Piece of mind is what I got. Best wishes for you and your journey

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@jawold thank you for sharing that. Of course I can't know yet- but it resonates that this decision and waiting is a big part of the challenge. I'm really glad you now have peace of mind.

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sally484 | @sally484 | Dec 18 12:13pm

I had my treatment before my surgery................chemo and radiation first then was given the choice of masectomy or lumpectomy. I opted for the lumpectomy. I was put on Exemestane after the surgery. The AI's are the worst of the treatment!

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