Lumpectomy or Masectomy

Adnerb23

I am nearly finished 16 weeks of chemo - 8 weeks of fortnight AC and then 8 weeks of Taxol.  I am also Hert 2 so started Herceptin on 26th August every 3 weeks for 48 weeks.  Due to have surgery in about 20 days.  I had a 4-5 cms tumor left breast which has shrunk with chemo to 1cm and nothing in between and 1cm - which oncologist thinks could be 2 x 2.5cms tumor joined together - wont know till surgery.  Also had spread to Lymphn nodes so will take out about 2/3 which is 20 out of 30 lymph nodes. Oestrogen + 30% Progesterone - and Her 2 positive. Invasive ductal cancer grade 3.  Options now are (1) lumpectomy with reduction (2) Bilateral mastectomy or (3) Double Masectomy  (all with lymph node removal). The first option could be do lumpectomy with margin and lymph nodes and go back following week for reduction in that left breast and if pathology shows more needs to be done could do mastectomy week after? Any recommendations or thoughts?

Sister

I think that, if your medical team has not given you any definite guidance on which option, you have to think about what you can live with as no-one else can do that for you.  The recommendation these days to doctors seems to be to go in with the least intrusion possible but it should also take in your preferences as only you know what you can manage (which seems to be what your doctor is offering).  I'm sure that if you choose the minimum, if there is any doubt about margins, you will later be advised to have a mastectomy.  My suggestion would be to write down your pros and cons for each procedure.

For me, I started with a lumpectomy, only to go back in a couple of weeks later for a mastectomy due to the margins.  At the time, my surgeon said that we should only be considering removing the affected breast.  Twelve months later he said that if the scanxiety got too overwhelming for me then we should consider removing the other one.

Adnerb23

Thank you Sister - Yes they did say that they initially could do lumpectomy with 20 lymph nodes and get pathology to check it all and a week later can either do plastic surgery to reduce or bilateral mastectomy or double depending on outcome of pathology so this might be a first option - thank you so much for the reply - much appreciated