Two lumpectomies, need another or do I go for mastectomy?

Going through breast cancer treatment Surgery
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Hi everyone, I’m looking for some advice before Monday 8th November. I was diagnosed with right breast invasive ductal cancer on 20th July 2021 (my 56th birthday), decided to go for a lumpectomy. On 16th August I had my first operation of right ultrasound wire wide local excision including nipple areola complex and sentinel node biopsy, the histology came back has having removed 24mm, grade 2 invasive ductal cancer with associated intermediate grade DCIS which extended to less than 1mm from the inferior margin and one out of one positive sentinel node. Before the operation I had developed a severe Bronchospasm, which they are still unsure why, as I couldn’t be tested on due to lack of phials to test my bloods. 

My surgeon said I needed another 2mm taking from the area, this was done under general anaesthesia (without complications) on 8th October 2021. The histology for this was that there are still no clear margins and therefore I will either need another margin clearance or mastectomy, if I go for the margin and it’s still not clear, they advise a mastectomy anyway. 

So, catch 22 do I go for margin clearance or mastectomy now, I had spoken to my husband about this and had sort of decided to go for a mastectomy if it still wasn’t clear, but now I’m really not sure has anyone had to make this choice!! I have already decided to have radiotherapy on my lymph nodes as I feel it’s probably less likely I’ll get Lymphoedema. 

Any advice would be gratefully received.

Thanks 

Sara 

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Crikeybobs @Hadley207  

What a horrible time you’ve had of it, in just the last 6 months!!

I have to admire your persistence and keep being knocked back, due to failure in achieving “clear” margins. Your latest Offer being yet another lump/mass removal, and if STILL not clear margins, then a mast. Afraid, I’d give in to a mast, get blummin rid, rather than yet another attempt. Plus, If your afraid to lose the whole lot, the recon options are fantastic these days.

Are they talking about having to “remove” any of the lymph nodes, with whatever next surgery you choose (either another further lumpectomy or mast)? Or to just treat them with rads, which is more a precaution against any possible spread, as opposed to it reducing the risk of lymphoedema? If the former, i.e. removal, then yes, you may have an increased risk of developing “lymphoedema” at some further stage. But NOT if you’re careful afterwards. 

I was offered lumpectomies with rads or masts with full node clearance. Opted for mast and full node clearance with 1st, 2006 and 07 was a no brainer decision - just to get rid, to avoid/reduce any further possibility of recurrence.

Have never had any prob with lymphoedema developing. But AM always very careful with both arms. Avoiding jabs, blood taken from, BP cuffs, cannulas, bites, stings, scratches (wearing sleeves when gardening) and sunburn. 

Hope this all makes sense, and is of some help to you, flower. But I soo wish you well whatever you decide, and speedy healing.

Lots of love,  Delly  xXx 

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Hello @Hadley207

You have been through a lot and don’t have much time to make a decision  I was diagnosed in 2017 and had a lumpectomy with clear margins so haven’t gone through what you have been through. I remember reading a post from a lady who went through four surgeries and thought this would be useful for you. I am not computer savvy but this is the subject heading if you put it in the search bar.

Re: Close margins following second surgery

I  also think your decision may depend on your breast size? How will three surgeries impact on the size/look of your breast  I was lucky that my incision scar is under my breast and I just have a bit of irregularity to the side. From “face on” you probably wouldn’t know I have had surgery. 

Also, is there plenty of “margin” to take? How close, for example, is the incision from the skin or chest wall?

i would encourage you to speak to your Breast Cancer Nurse who maybe able to answer any questions you may have. Or try the nurses on here (number at top)

i am the type of person who likes to do a lot of research before I can make an informed decision. I wish you well for your decision and surgery. Michele