I was diagnosed in March, with a grade 2 tumour of 4.1cm. I’ve just finished six cycles of pre-surgery chemotherapy. This was to hopefully shrink the tumour and avoid a full mastectomy. It would also have the benefit that the effectiveness of the chemotherapy could be assessed.
I’m just wondering, assuming a lumpectomy is feasible, what relationship age has with the lumpectomy/mastectomy decision? My surgeon is inclined to do a mastectomy due to me being 30. But I’ve heard other people say that they prefer not to do a mastectomy if you are that bit younger. So I’m a little confused.
He also thinks a mastectomy would be preferable because, even though the chemo is working well, there may be parts of the cancer left behind. But I thought that this is why they remove the extra margins and also why I would be having more chemo after my surgery. So again, I’m hoping somebody can shed some light on the logic of this one.
I would prefer to just have the lump removed. I know it’s not the most important thing and that I sound really vain. And I know the reconstructions are great. But it just seems to be so much more complicated to me. It’s so much extra surgery and time-wise it just seems to drag this thing on even longer.
I’m sure the right decision will be made but if anyone could help me with my confusion or share their experiences I’d be really grateful.
hi Cathylyn
I was 37 when i had a mastectomy and immediate recon, i wasnt really give an option as i had 2 tumors multi focal, even though they were saying it was invasive they knew that 1 of them was not and it was high grade, your right about it being extra surgery my op lasted 10 1/2 hrs but i feel it was the right decision. At the end of the day talk to your onc and ask him everything you want to know at the end of the day its your right, I have never heard about the age thing but you never know do you Good luck with whatever happens x
i was a perfect candidate for a mastectomy before my neo-adjuvant chemo, but luckily I got a complete response from chemo, and no one (I saw 3 different surgeons to make sure) advised a mastectomy. It was me who insisted on asking to make sure I was not compromising my health for vanity issues. All 3 of them (from 3 different hospitals), said I had nothing to gain from a mastectomy in terms of prognosis. I have also read research that says there is absolutelyy no difference between a mast and lumpectomy + rads in terms of survival/recurrence (this was published on a magazine for health professionals that someone working for a cancer charity has passed on to me). I thought a lot about it and decided a mastectomy was not for me. I just couldn’t tolerate the idea, especially of the long process of reconstruction as it seems so many have problems with it, and didn’t think I’d have gained much from it.
I think you can see the age thing from 2 perspectives:
being young means you have more time/chances of recurrence
2.because you’re young you might not want what is in effect mutilating surgery. (theory behind this that as you get older you care less about your physical appearance)
That’s my 2pence, I sincerely hope chemo works for as well as it did for me (I was coming from a 5cm lump, grade 3, 2 lymphnodes prognosis, I was officially NED even before surgery, exceed all expectattions…feeling very very lucky)
If you have the choice between lumpectomy & mastectomy I would choose lumpectomy if you can. A mastectomy is very disfiguring and although they show you pictures you dont necessarily finish up looking like what they showed you. A recon is a further big operation as well. I speak from experience regarding mastectomy as I also had multifocal tumours and was not given any choice. I also thought that was the purpose of the preop chemo to shrink it to avoid a mastectomy. It is also my impression that they do try to save the breasts of younger women more as younger women seem to be the ones who get offered preop chemo. I have not heard of many older ladies being offered it. But then again maybe they do not want it.
Thanks everyone for their help. I’ll take Webmum as my favourite – she’s telling me everything I want to hear after all with her fantastic results!
Of course you’re right about the age thing Chiara, there’s arguments both ways. I think I was just a bit annoyed that he’d brought my age into it as an argument when I was so far into the process. They always knew how old I was.
Anyway, I had a mammogram and ultrasound last week and the radiologist seemed very impressed with how it was going and said that the tumour had almost gone altogether. I’ve a MRI scan this week and hopefully that’ll show the same thing.
So we’ll see what the surgeon says to me this time. He just got me a bit confused with his mastectomy opinion – it was as if I got 95% in an exam and he’d decided to fail me anyway! But to be fair, he was basing his opinion on a physical exam and stressed that he couldn’t say anything definite without the imaging being done. So here’s hoping……
I hope I don’t sound too image obsessed, but I’ve been trying to focus on the chemo as the ‘save the boob’ campaign – trying to deal with the whole experience in smaller bite sized chunks I suppose. And a 10 ½ hour operation is huge, and the recovery time, and the fact they have to get the tissue/muscle from somewhere else, and the booster (?) injections and what not. And yes apart from all that there is some vanity involved too.
Starfish, yes I’ve heard that they often offer neo-adjuvant treatment to mostly younger women. I’m not really sure why but it seems to me that, apart from the extent of surgery necessary, the big advantage is that it can be seen how well you’re responding. On the other hand though, you have to live knowing what’s inside you for that much longer.
morning. this thread seems about closed, but wanted to add a bit of reality to it for you.
I am an “older” woman, had neo-adjuvant chemo, six treatments. They did not work, tumor grew. Therefore, had mastectomy. We had hoped for lumpectomy, but not possible. Statistically, the prognosis for lumpectomy vs mast are the same; therfore, the trend is to go with the less invasive surgery when possible. However, the whole idea of taking the tumor is to get rid of the cancer. In my case, the tumor was large and the cosmetic results of a lumpectomy and the margins they need to take would leave very little. Hence the MS. I am in the US; my surgery was 2 hours, not 10.
Recon can also be implant OR flap (tissue from other places in the body) and statistically 98% of women with recon would do it again.
Webmum - I am sure you very innocently noted that since people are older, they don’t care about their appearance. However, you might want know that appearance and even sexuality is important to folks at every age. It is important to me. I have found, however, that despite my new appearance, true family and friends love me to pieces. It is really who you are more than what you represent, it seems. This forum has women who have had to have many things done to them they would not have preferred; however, in the name of living, they do it. You are the not first to use the word Mulitlated in terms of masectomy; and I cringe each time I hear it. I do not consider myself mutilated; I consider myself saved so I can live with my OH and family and see my granddaughter get married one day. The tone of that word, which I am sure you didnt consider, is that the doctors ready to hatchet us to pieces; nothing could be further from the truth. We do this with full recognition of the results; and we approve of living more than appearance. Enough said…
In general, I realize that posting gives the illusion of privacy; and this has been a private conversation among you all. I wish you the best with your decision and treatment cathy. Unfortunately, it is not private but very public. There are many women on this forum who have suffered terribly through primary diagnoses through secondaries. Please be aware of their feelings.
I agree i dont like i have been mutilated i also feel that i have saved at the end of the day they only do what they feel neccessary , in fact when i first got dx straight away i asked for a mastectomy and the Doc replied well hold on lets see what the results say but as it turned out i did need a mastectomy i feel that age does not comes into it as i said before i was 37 but using the term mutilation is a very strong word to use…
I have seen a book on management of cancer for doctors which says that mastectomy is mutilating surgery and I suppose it depends on your pespective. Most women who have been surveyed in research I’ve seen think that the results of surgery is better in appearance than professionals who were asked their opinion.
So I suppose people with breast cancer are more accommodating about how surgery looks than health professionals. Not that you’d know from talking to them patient to doctor/nurse as they are not going to say what they really think necessarily.
That’s why I like to read the books for doctors as they are far more frank in them.
As you might conclude I have my own view on this matter and would have preferred not to have surgery of any kind for a number of reasons - I don’t like assymetry, I don’t like pain, I don’t like wound infections, and I don’t believe any kind of mastectomy cures breast cancer. Ultimately I would like to see cure which does not involve surgery but maybe I am being naive at least for the next thirty years.
I had a segmental mastectomy by the way, which involves cutting off about a quarter of the breast as I had a small tumour (under 2 cm) with focal DCIS, all low grade.
…or perhaps it is not adjustment but gratitude at being alive and rid of the cancer, Mole.
All of us would prefer a cure rather than surgery, but it is not here yet.
So we make do with what options we have now.
Mutilation has a tone to it that indicates it was violently and recklessly done; most doctors prefer not to perform a mast unless necessary. And we consent to it all, it is neither maiming nor horrific; it is life saving. Big diff.
Just read your thread and I thought I’d reply.
I’m 34 and I too was diagnosed with a grade 2 tumor, they thought mine was small but it turned out to be a little larger than yours at the WLE it was 45mm with no clear margins. Pre- cancer within 1mm of margin so I was told that I had to have a mastectomy, which I had 14 July with recon which took about 2hrs, when I had my results they said no residual so it did the trick and I still have a boob to the outside world. Just glad that it’s all gone as I had no lymph node involvment, now I just have to decide wheither I want chemo or not.
I can only give you my opinion and my experience but I’m glad that I had it done as it has given me more time with my kids and not have to worry if they got it all.
All my friends are a little envious as my new boob looks better than they old one and they have said that I’m gonna have a better pair when all’s finished. Lets hope so. Might give Jordan a run for her money. (hahahahahahaha)
Emily I’m very sorry to hear the neo-adjuvant chemo didn’t work out as you’d hoped and I hope your treatment has been going better since your operation.
But I’ve been thinking about your post. Maybe I’m misinterpreting your comments but it seems to me that you’re saying I shouldn’t be expressing my preference for a lumpectomy because some people have bigger concerns? I’m sorry but it does matter and I want to understand the issues so that I’m prepared for my next appointment with the surgeons. I’ve done some research now and I feel that I am now much better informed. I didn’t know for instance that the prognosis is virtually the same with a mastectomy or lumpectomy + rads. Yes I am that ignorant and clearly it is something that’s important to know.
Just on the other issues raised…about the age debate, I don’t want to be putting words into her mouth but I think Webmum was suggesting that this may be a theory among the medical profession rather than expressing her own opinion.
As regards the word mutilating, I agree that it’s a horrible word. Technically though maybe it is a correct word? Sorry, I don’t want to cause more arguments and technically correct or not I don’t like it. You’re right, it does sound violent and reckless and this isn’t the case as we know.
the term mutilate comes from the Latin mutilare to cut off and that is what mastectomy does. Obviously there are emotional connotations to the word now which have grown up around it, but personally that’s how I look at it. I don’t feel grateful about being spared from dying though, I’m very vain and I preferred my bosoms as they were.
I also think that we are very much beholden to the medical profession in what we get Until the late 1970s women had to sign authorisation pre-testing of the lump they had to agree to have a mastectomy if cancer was found. There weren’t any biopsies, and a woman would wake up from surgery either with a breast or without one depending on what they found in frozen section. Yet about half the women diagnosed with breast cancer went on to die from it. It was only later that they realised that breast cancer is a systemic disease which is why we now get treated with hormones such as tamoxifen or have chemo, on the assumption that cells may have spread elsewhere in the body. Everything I read seems to indicate that deaths from breast cancer occur through secondary deposits elsewhere, not from the primary tumour in the breast.
Breast conservation seems to have started because some US women refused to have mastectomies then some doctors ran a trial which showed that for tumours below 4 cm the mortality rates for lumpectomy and mastectomy were the same.
So it wasn’t really until feminism took off and women were prepared to take a risk that lumpectomy might work as well as mastectomy that they stopped doing them automatically. Years ago in my teens I saw a picture of a woman who’d had a radical mastectomy which is why I didn’t check my breasts ever. All the muscles on her chest had been removed as well as her breast tissue because until the 1970s that’s what they did.
I think that there have been some improvements since then. Some reconstructions are pretty good, but there are sitll not that many plastic or oncoplastic surgeons around with the skills to perform them and I’ve seen some pretty poor cosmetic results. But then beauty is in the eye of the beholder, and maybe it is only skin deep.
cathy-
if you knew me in the least, you’d know that is the furthest from the truth. none of us should ever decide such things as surgery without understanding the exact repercussions and choices. I would expect nothing less from a woman who is undergoing the very heavy decision between lumpectomy and mastectomy. Neither is an easy choice.
I commented on the word mutilate which is insensitive and offensive. I noted that there are times when women, like myself, do not have a choice. In other words, be careful about how a situation is discussed, it might be someone’s reality. And I noted that the age of a woman is not significant to appearance; because one is over 30 does not mean one loses sexuality, feelings or concern for the body. To the contrary!
i start radiation on Monday, 7 weeks, 5 days a week. It should seem daunting, but it signals to me the end treatments!
No hard feelings, cathy. I hope that your decision is made with confidence and your treatment goes smoothly. We are in this together on this forum, no matter where we may be geographically!
Just thought I throw in my experience. I’m 46 and had a WLE (tumour was stage 3 and 27mm) and sentinal node biopsy in June, margins and nodes were clear. Prior to surgery my consultant said it was my decision whether to have a lumpectomy or mastectomy but there was no difference in prognosis. The indication I had was a lumpectomy on ladies with larger boobs (I’m 36DD) would probably be more pleasing, but the decision was still mine. This is what I opted for and they made an excellent job, my boob has retained its shape and the scar is very fine.
I hope everything works out OK for you and the outcome is what you want.
right I’ve just been typying away for half an hour trying to make myself clear but when I tried to post my comments there was a problem…sorry I don’t think I can retype it all over again…
Anyway in a nutshell, Cathylyn has already explained that I was not giving my opinion regardinf age and mastectomies, but rather they way some doctors address the issue. At leastt this is something I heard quite a few times when I enquired whether a mastectomyy would have been better: “given your age…” (which is not under 30 by the way).
I don’t know where the sex comment came from, I said nothing about sex and I certainly do not think there’s an age limit to having a sex life or concerns about one’s appearance, nothing farther from the truth.
as far as tthe term mutilating is concerned, I do not find it offensive applied to me, I feel mutilated by my lumpetcomy and radiation burns and all the scars in my body, reminders forever of the terrible 11 months I’ve been through. I truly think it’s horrible that we have to lose bits of our body to save our lives, and to be honest I thought most women would have felt the same about it. I did not think for a moment that it would have been seen as “defamatory and offensive”, or I wouldn’t have used it. So I sincerely apologise for causing offence to anyone, and to you Emily in particular,it was not meant that way at all. I do think about other people feelings’ before I post, but I suppose people find different things offensive so it’s not always easy tto make a judgment call.
hope this is clear enough, and there no more misunderstandings, and I wish you all the best of luck with your treatments,
e special good luck to Cathylyn, please let us know how you get on.
hi everyone,i,ve been reading these postings with interest as i,ve recently had a lumpectomy myself and have been a little surprised with the end result. Naively i thought it would hardly make a difference to the breast but in my case it looks a bit like a souffle. Its only been two weeks so i realise its only early days but it doesnt stop me being bothered by it and then feeling guilty when i realise without it looking like that i wouldnt have had the prospect of a full life.
I am a woman of 45 and have always tried to look after my appearance and so far havent done a bad job. I have also read things on this forum which have quite frankly scared the living daylights out of me,but i have never felt that those people shouldnt have written what they have. They have a right to discuss how they feel and we do have the moderator to censor anything too ofensive.
What i,m trying to say is that its important to be able to discuss things openly,honestly and without the fear of offending anyone.Also that if a particular thread is not something you agree with then dont read it,anf think carefully what discussions you open as there are some on here that you will find are more upsetting than this one
Hi all, four weeks ago I had a lumpectomy which didn’t work, three weeks after I had a mastectomy, when I went for results was told the masectomy had achieved what was wanted clear margins. I am starting chemo and rads in two weeks. I am 58 am the mother of 2 and grandmother of 6. I care very much about my appearance, and have been married to the same man for 39 years. I like to look nice for him to come home to. I have to come to terms with the mastectomy which is not easy but hopefully it has saved my life that is the way I am thinking about it. I know from reading on here that chemo is not easy for everyone but I also know I have to take the chance I have been given. I do not think of it as being mutilated, I feel very grateful to the doctors and nurses who have been brilliant and without them who knows! I hope all make the right decision we are all different it wouldn’t do to be the same but we have to weigh everything up. It is a rollercoaster and everything happens so quick but as I have said before it has to, there is no time to waste love and best wishes to all of you junieliz