Hi, I’m helping my spouse with some research for her breast cancer treatment. She has a single tumor that was caught relatively early and is opting for a lumpectomy. One of the things we are finding out is that clean “no ink on tumor” margins are not 100%. There is always a risk for needing reexcision.
What are the different techniques people have experienced during surgery to reduce reexcision and did it work?
Hi @sometimes.me I’m not really sure of your question regarding techniques. It is entirely down to the surgeon to get clear margins, if they can due to tumour location. They try to get a number of millimetres (say 5-8) clear tissue out with the tumour, which then goes away for intensive testing. On occasions, the pathologist will discover cancer cells in the margins which then requires re-excision. When I had my surgery, the surgeon warned me it might happen and told me it happens one in every ten surgeries but that is purely anecdotal. Can I suggest you give the nurses here a call on 0808 800 6000 after 9am Monday to Saturday (lines close at 16.00 M-F and at 13.00 on Sat). You can talk over the procedure and your concerns with them for better clarity. I do hope your wife’s surgery goes smoothly and successfully.
I think it is a really hard call by the surgeon and only the pathologist can see if has been successful. I had to go back for a wide excision after lumpectomy. My Mum had to have a mastectomy after initial lumpectomy. Both of us coped and recovered well. Many do fine without further surgery
Best wishes.
I was told that my margin was 4mm in one area so it was recommended that i had 5 boost radiotherapy sessions as well as the 5 whole breast ones that were already scheduled. Reexcision was not felt necessary at 4mm
The surgeon can at his discression decide to opt for a ‘cavity shave’ if he is unsure about margins. I had a lateral shave of 1cm done, which actually turned out totally clear, so you could say it was unnecessary, but better to be sure and goid to be clear. It probably depends on size of bust and cosmetic outcome as to whether to do this. I’m pretty large and where it was hasnt changed the shape overall.
I think you just have to be aware that the first lumpectomy might not do it. For me the second lumpectomy didn’t, either, and I ended up with a mastectomy.
My lesson from this was that until surgery (for me, 2 surgeries in), it’s a bit of a guessing game for all concerned. I’d had 2 biopsies and ultrasound beforehand and they still had no real idea what they were dealing with until the mastectomy was done.
I’m sorry that’s not reassuring, but I wish someone had helped me manage my expectations in a realistic way. The good news is that the train does eventually come to a stop. You will get your answers and a solid plan, even if it takes a couple of tries. I know the uncertainty is miserable in the meantime, but it will end.
Hindsight being 20:20, I wish I’d just had a mastectomy after the first lumpectomy didn’t get it all. But the truth is, you can only do what you feel able to do at each turn, and for me that was following the surgeon’s recommendations.
Warm wishes to you both x
It seems to be a bit of a mystery. I had less than the NICE recommended 1mm margin and was given different reasons why a cavity shave was not necessary.
hi cosy. sorry to hear about your challenging experience with multiple surgeries and uncertainty. When you say they didn’t know what they were dealing with until the mastectomy was done, is it because the cancer had spread?
thanks! I’ve been reading about tools and techniques that provide the surgical oncologist with more data that helps improve the likelihood of negative margins.
For example, “flourescence guided surgery” injects patients with a dye that can highlight cancerous tissue.. Other methods include having a pathology done during surgery. I’ve read about something called a “frozen section pathology” that may be more challenging for breast tissues given the fatty make up. Some people have mentioned a regular pathology during surgery.
I know the surgeon’s experience is a strong determining factor. It’s still difficult when such an important factor in the surgery’s success can be of a craft than science.
I want to know how the “really hard call” as @edp puts it, can be a little less difficult to feel more confident in the treatment plan.
Ah, I see. I had my surgery three years ago and there was no discussion with me regarding technique at any time. I strongly suspect that the judgement call on how much tissue to take was made subjectively through experience rather than the use of measurement tools. I have a vague memory of being told that a pathologist looked at the tissue whilst I was still under anaesthetic (but it could not possibly have been the full panel of tests at that time) so I assumed this happened for everyone. The surgeon did say she thought she had got clear margins during her post-surgery visit - which she had. Mind you, I had a smallish IDC together with some low grade DCIS in the upper, outer quadrant, so not a complex job to get it out. No doubt a discussion with your wife’s surgeon will clarify what options are available.
It’s because they never seemed to get a grip on the size until the mastectomy, at which point they also found a higher grade they’d missed through two biopsies and two lumpectomies.