Lumpectomy with radiation or Mastectomy?

Hello there, I'm sorry this is showing up in your life but glad you are being presented options.
I don't know any of the traits of your cancer, but it sounds like your doctors think that lumpectomy would be fine.

My cancer was on my right side at about 7 o'clock, IDC, grade 2/stage 1, 18mm in size, ER+ and PR- and HER2- (it's the PR- that makes mine a little more sinister)

I was presented with the same option and chose lumpectomy and radiation. Both went easily and healed well (no node involvement, good margins). I know that radiation side effects take a long time to fully manifest, so I am doing things like long gentle daily chest stretches and ongoing moisturizing protocols to help it along. Going well. I have full feeling everywhere and scar lines are modest. I had a mild rash area about as big as my palm that just itched, easily handled by various creams. When I look at myself in the mirror now I can't tell there was anything done, except slightly more dimpled skin in a few spots.

My reasoning was personal (as yours is too): In my case, I couldn't handle that much destruction of tissue, even if it would allow me to skip radiation. My body hasn't been cut into a lot, and it's traumatizing to me on a deep level. Your situation might be different based on the traits of your cancer and your feelings on the subject.

I'm still pondering the aromatase inhibitor topic. That's a tough one for me, for quality of life reasons.

Not sure if any of this helps but I am sending you my best wishes!

I was diagnosed with cancer in both breasts, stage 1 and 11a/grade 2. ER+ PR+. Early stage...however 1 site of invasive carcinoma, 2 sites of in-situ and 2 sites of ductal hyperplasia (just waiting to turn cancerous).
Final pathology report found invasive cancer (not in-situ as thought). A total of 4 potential lumpectomies.
Radiology out of the question for me because of ischemic heart disease. Radiation can cause scarring of the heart and my heart is damaged enough. So, after some debate, felt the bilateral mastectomy was best for me.
I pondered implants for a bit. But at age 70 with several serious health issues, I felt I did not want any potential complications down the road. But I was afraid I would look in the mirror and feel psychologically "damaged" looking at my flat chest and feel beyond terrible! This never happened, I felt I had to get rid of the poison in my body. I am completely fine with no breasts, husband supportive and have NO regrets.
My oncotype score (you will find out what this means) was under 25 (good) and chemo not indicated for me nor radiation with no breasts. Only the AIs medications recommended and I am on Anastrozole 1 mg. daily for 3 months now...but must take for 5 years. And the side effects are minimal...however one must watch and do all they can to prevent osteoporosis plus I was in between a rock and a hard place with my ischemic heart disease. The AIs can cause a heart attack or stoke if you have this heart condition. My cardiologist gave the go ahead to start the AI. What's was the alternative? Do nothing and hope/pray the cancer doesn't reoccur? I had to do exactly what was recommended to my by my oncology team - not only for myself but for my family. I couldn't live with myself if I did not take the AI and the cancer returned. My story completely different from yours as all our situations are. This is just my story and my thoughts. It is not easy by any means...do your research. Ponder the pros and cons of each surgery. I asked myself this question: What is the BEST way to avoid a cancer reoccurrence in the future? This was my answer. And you must know this already, no matter WHAT you decide upon - there are NO guarantees on any procedure. Your post surgical procedure for reoccurrence might be "low"...but it is never zero for anyone. All the best to you on your journey - the journey no woman ever wants to take.

I had IDC at 5 o’clock. Very small 7mm. Also DCIS 4cm. 99%hormone positive .I chose a lumpectomy and reconstruction (they did at same time) I had 15 days radiation, with a booster. Then started AI drug.
- that was 2 years ago, I was 60- silver lining, having nice young boobs.

Let me know if you have any more questions.

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.

When I had my diagnosis of Stage 2 invasive lobular carcinoma the surgeon told me the survival rates were the same for lumpectomy + radiation or mastectomy. He also said the chance of not getting clean margins around the cancer was 25% for the lumpectomy. I decided before the surgery that if the lumpectomy failed I'd have a mastectomy. Which is what happened. He did the mastectomy a month later. The surgeon told me some additional cancerous tissue was found in the breast he removed but that was what radiation is for - it will destroy any remaining cancer that might be present, which is why survival rates are the same between the surgical options.

The decisions for treatment pathways are so personal and so dependent on one's own sense of risk and comfort, as shown by all these different stories in this discussion. Thank you to everyone sharing these deeply personal experiences.

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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Thank you for sharing this. The decision is different for all of us...not easy. I have a couple of questions. How do you know if your lumpectomy "failed"? And did you have any trouble with the drains? From what women have told me, the drains can be a hassle.

For my friend who had a lumpectomy, her doctor told her after her surgery the he was unable to get clean margins. They had to go back and she opted to have a bilateral mastectomy after this experience.

As for the drains, I did not have any problems with them. I slept in a recliner with the drains in a holder of the bra I bought at SOMA which was comfortable or in the inside pockets of a light hoody I bought on amazon. You just have to drain them out and measure the contents and write it down. The plastic surgeon used the measurements to determine if they can be taken out. I think I had them all out within two weeks. I bought a holder to go around my neck to put the drains in when I showered. That worked beautifully. I also bought a pillow to go in the front around my body that I used all the time and it felt secure. There is a kit with both of these items and others that I bought online from a small company and they were wonderful. The pillow had an outside pocket for my phone. It really isn't too bad. I wish you the best in making your decision. Happy to answer more questions.

I had a grade 2 idc, deep, almost on chest wall. HR+, PR-, Her2-. Double mastectomy was not discussed, just lumpectomy or single mastectomy with/without reconstruction. While mastectomy would have prevented radiation, I would still need ai therapy and, as it turned out, chemo. I chose lumpectomy because a) didn’t want to go overboard with surgery - to me mastectomy for this single tumor seemed to be a little much and b) it would put me in special bras with inserts on one side for the rest of my life because I would otherwise be one up/one down. Luckily had an excellent surgeon and hospital with in surgery path department so they read the margins during surgery and she was able to take more tissue for clean margins without a second surgery. Oncotype testing out me into chemo followed by 4 weeks of radiation. For me, the chemo has caused the most long term side effects still present almost 2 years later. There were 2 areas of damage to lung from radiation which may be permanent but currently not causing problems. Yes I still have to moisturize the breast tissue as they consider radiation “the gift that keeps on giving” but don’t really have any major problems with it. If I do get a reoccurrence, will consider bilateral mastectomy.

My surgeon also gave me a choice of a mastectomy or a lumpectomy. The cancer had moved into only one lymph node and I had previously had chemo and radiation. I opted for the lumpectomy at which time she removed a portion of my breast and quite a few lymph nodes just to be safe. I have never regretted it. My breasts weren't that big to begin with so it's not really noticeable.