Debating Lumpectomy vs Mastectomy /Pathology Change?

Sure- you can go back and have a mastectomy after a lumpectomy. I did that - and I wanted it done as soon as possible. The mastectomy was just over four weeks out from the lumpectomy.

BTW my insurance paid for both. I was BRCA negative, but had two other mutations that are suspect for breast cancer and maternal BC in aunts and second cousins- and most importantly my lifetime BC risk score was 35. If your score is 20 or above you would qualify for a prophylactic procedure...and due to Womens Health and Breast Cancer Act 1998 you qualify for full coverage if you are in the US. That coverage includes reconstruction. I chose to remain flat and opted for a surgery called aesthetic flat closure over implants.

@anatomary I had a lumpectomy in 2001 and had to return for more circumference from very small tumor. Now, many years later having discovered lump that was not biopsied (“nothing to worry about about”)—until 1-1/2 years later when I was immediately told ILC. I’m scheduled for limping March following 9 months on AI’s. Having several side effects and have decided I just want a mastectomy and get it over with. Very tiring and psychologically draining me. I know it doesn’t necessarily end there but honestly at this point I’m more concerned about all the side effects over the cancer. Wishing you success in your journey.

Thank you - I had a lumpectomy in 1998 that turned out to be a fibroadenoma. Microcalcifications were found on Mammography in late April - and near the same area, stereotactic biopsy revealed atypical ductile hypertrophy (ADH) in May, lumpectomy pathology was more ADH and lobular carcinoma in situ (LCIS) which increased my risk of breast cancer in the opposite breast so we ran my genetics- and that's when I got the score of 35. I had a prophylactic DMX in July - that path was clear and I didn't require further treatment (radiation, chemo, etc). My new lifetime risk score is 2-3% - but the score will go up as I age... as it does for everyone. I'm currently 64. . I went with the DMX to avoid further lumpectomies/surgeries, hormones, chemo - and over high risk surveillance of a diagnostic every six months. I did not want to experience "life interrupted" every six months while I waited to find out if there were any suspicious findings. 5 to 10 years of tamoxifen was not very appealing either! I also considered having a prophylactic DMX earlier in life was better than waiting since healing takes longer as we age. I have healed well, and while I greatly reduce my risk of BC in the future, I still have to monitor my chest wall for BC. This is the typical monthly manual that we would do for ourselves anyway. I will continue to see my breast surgeon for two years and an annual manual from her to ensure I am clear. I worry a little bit that some cells from the LCIS may have snuck out, and I could get metastatic BC later. My surgeon admits this could happen, but it is very very rare -this has lessoned my concerns. This past spring -summer was just crazy; so many decisions -and so much learning in order to make a decision! Hearing from others on Mayo help me make decisions - I'm grateful to everyone who has shared. Good luck in your journey!

You have pointed out that there are things you don’t know when you choose your procedure. I had TNBC with the ATM gene. I was told I could have a lumpectomy, but opted for a mastectomy. I also wanted to avoid radiation due to the location of the tumor. At 72 I wanted to heal and move on, but I also had some small amount of lymphovascular invasion and microscopic DCIS in my tissue, that is only discovered after surgery. I was told that my choice was wise due to these discoveries. Ask more questions and make the choice that is right for you. I have no regrets.

Excellent!

Thank you to everyone for sharing their experience.