Re-excision

So gutted - just found out yesterday that clear margins were not achieved despite my surgeon saying they had been.  I had surgery in November, I have had 7 rounds of chemo with one more to go next week.  I wasn’t particularly confident with my onc so I sought a second opinion and the result being that the new onc discovered through having my histology re-analysied that clear margins had not been achieved.  So do I switch to another surgeon (I am lucky as I am a private patient) or should I return to the first one as he did the original op and may well know where to look!  I don’t know how difficult it would be for a new surgeon to operate and achieve a clear margin.  Any advice welcome.

What a pain for you. Unfortunately based on my experience I think it is hard to predict and also possible for specialists to disagree. I started with intermediate DCIS on one side (picked up by routine screening) and to be honest I always wanted mastectomy but was persuaded to try WLE. Margins not clear (unexpected low grade DCIS) at which point I opted for mx. Afterwards I was told this was a good decision because mx revealed extensive areas of surrounding cells were in the process of changing so doubtful there could ever have been ‘clear’ margin for me. Few months later (largely through luck) high grade DCIS found in other breast.This time surgeon agreed to go straight to mx (I did not want WLE) - again proved to be a good decision as this time mx revealed invasive cells. Nodes clear and surgeon thought it was OK and no more treatment required - but onc did not like the way it was ‘behaving’ and it was HER positive. Onc thought surgeon’s view was reasonable but disagreed with it and in the end I folllowed onc’s advice and went on to chemo, herceptin etc to reduce the risk of it coming back. I understand why you feel gutted - I felt exactly the same both times but particularly after second mx.

 

I am sure things sometimes get missed but in my case I don’t think anyone could have told. With hindsight I wish I had only had one op not two on the first one but I understand why surgeon wanted to try WLE - I was just unlucky in that it would probably never have worked for me but doubt anyone could have known that at the start. On the second one I went back with a lump and the repeat mammo/u/s looked clear but luckily they did biopsy as extra check not just on lump (which ultimately was harmless) but nearby which showed the DCIS - but only the mx revealed the invasive cells which were somewhere else (‘hiding’ according to the onc). I had confidence in both surgeon and onc and they were both willing to discuss and explain which was very helpful. In the end however they did not agree over the best course of action after second mx so I just had to make a choice.

 

I hope you can discuss with new onc and the surgeon (new or original or both). I would have expected them to discuss it anyway and come up with some recommendations for you - even if they might disagree so that you have to choose between options. Very best wishes - it is not a great place to find yourself but if it is any help at all I did feel better once I had made the decision to go with the onc’s advice and had a plan again.