Lumpectomy with radiation or Mastectomy?

I was diagnosed with DCIS in right breast after a lumpectomy 6 months earlier due to atypical hyperplasia in my left breast. I did not want radiation or hormone blockers so I chose double mastectomy ( skin and nipple saving) with immediate reconstruction. I could not be happier with my decision, I am 68 but active and fit. I am 10 weeks post op and almost back to full activity. Both surgeons did a great job. As a note… the pathology showed the atypical hyperplasia was in a new spot on my left breast…. So for me the mastectomy was the way to go.

I was offered the same option and chose a bilateral mastectomy. I will honestly share why I did this for your consideration but understand that this is a personal choice for each of us.

I had a lengthy conversation with the plastic surgeon who works with women who have had breast cancer and wanted reconstructive surgery as well as women who have had a lumpectomy and radiation and needed reconstruction following its effects. He honestly told me that depending on the radiation treatment (length of time and place in the breast etc.) he found it very difficult to do much for women whose breast became disfigured following radiation. He said the skin is not able to handle surgical reconstruction because it is so damaged and this can happen years following the radiation treatment. He sees women when they have one breast that is disfigured.

I felt that having both breasts removed also avoided the chances of my cancer coming back in the other breast (I had Invasive Lobular Cancer Stage 1A Grade 2 and no node involvement). I felt that I would prefer to have both breasts identical following cancer treatment. I had reconstructive surgery in May and now I have two smaller perky breasts and I am very happy with the result.

Because of the size of my breasts, the plastic surgeon was not able to save my nipples. He told me this before I made my decision about lumpectomy/radiation or mastectomy. I felt making sure the cancer was gone was more important than saving my nipples. I will have 3D tattoos done soon that look incredibly real. If you want to preserve feeling in your nipples they can do nipple sparing surgery but you should talk to a plastic surgeon to see if you are a candidate before you make your decision. If you are younger and your reoccurrence outcomes are similar, then your choice may be to do the lumpectomy. I would recommend a candid conversation about what your breast will look like years down the road following radiation.

I was able to avoid radiation altogether and I am also on AI therapy for five years. I had no pain following my mastectomies and rehab was fairly easy for me.

I don't know if my insight is at all helpful. To me I had a 15% chance of reoccurrence with lumpectomy and radiation and a 2% chance with bilateral mastectomy. I was happy to choose the latter option to make sure the surgeon got clean margins and avoid having to have a subsequent surgery. I also had a friend who had a lumpectomy and her surgeon didn't get clean margins and they had to go back and do bilateral mastectomy.

As others have said you have to weight your personal desires and your unique cancer markers against the likelihood of reoccurrence and decide which approach is better for you.

I wish you the best. There is a breast cancer treatment Handbook: Understanding the Disease, Treatments, Emotions by Judy C. Kneece which is an amazing guide my breast surgeon gave me. They sell it on Amazon. In the back of the book is a guide with questions you answer to help you make your treatment decision. I used it to decide about going the bilateral mastectomy route. I found this book to be immensely helpful every step of my journey and highly recommend it. Good luck. Whatever you decide will be the best decision ever.

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@wews Thank you so much for sharing your experience.
I was diagnosed with breast cancer again, after 22 years Cancerfree. 😞 This time it was found on my right breast. I just had 2 lumpectomies on the right breast. All margins/lymph nodes clear.
I had lumpectomy, radiation & chemo 22 years ago on left breast. I am 65 years old. I don’t want to do radiation again.
I’m having a hard time deciding on mastectomy. 😞

@lourdes2026 please get the book suggested in my first post. It is immensely helpful in making decision and moving forward. The mastectomy really wasn't hard - you just have to embrace having reconstructive surgery following it. Good luck - I wish you the best.

@wews Thank you so much for sharing your experience.
I was diagnosed with breast cancer again, after 22 years Cancerfree. 😞 This time it was found on my right breast. I just had 2 lumpectomies on the right breast. All margins/lymph nodes clear.
I had lumpectomy, radiation & chemo 22 years ago on left breast. I am 65 years old. I don’t want to do radiation again.
I’m having a hard time deciding on mastectomy. 😞

@lourdes2026 obviously no one can make the right decision for someone else. The questions I might ask myself and my doctor are about choices and outcomes. You know better than anyone that there are no guarantees but if you have a doctor you trust and feel you can ask, I would ask about choices and what could I expect from those choices. If you struggled with radiation the first time, you might want to make clear that would be a last choice.
If you are set against a mastectomy, I would discuss that too. Because your cancer is yours alone and the expected outcomes are as well. I hope you can get a great outcome from a treatment plan you can tolerate.
Have you received your biopsy results yet?