My first post and so confused...

Hi All,
This is my first post...I'm so confused and I have so many issues that need to be addressed.
 I am a 39 year old healthy mother of 2 and I have invasive ductal carcinoma stage 2. I've just had a lumpectomy last week, negative lymph nodes but the margin wasn't clear. We have booked in again to have another go at it.

My husband is now of the opinion that I should undergo a mastectomy rather than have a second lumpectomy. He's quite adamant. I'm emotionally unprepared to have the whole thing off. 

My breast surgeon doesn't think a mastectomy is necessary because she thinks she can get it all but cannot guarantee it.

Has anyone here had that issue where they've had to reopen a third time?

Not to mention the costs. She can only guarantee she'll do it if we pay for her private services. Where in the public system she said she isn't guaranteed to be the one to do it. So we are extremely out of pocket at the moment because of various issues with our private health fund who won't cover.

Hi @annie79  Sorry you have to join us on this forum but it has been a godsend to so many of us. Last year I was also diagnosed with Invasive Ductal Carcinoma stage 3 with no lymph node involvement.  I had my first surgery like you a lumpectomy, then they again widened the safety margins 3 weeks later.  ( this is quite a common thing as they prefer if possible to take the less invasive options.)  I then had an MRI to check everything and it was only then they found high grade DCIS  as well.   I went through the public system and I was very lucky to have a great surgeon who was 1 of 3 who specialised in Breast Surgery. My treatment was then chemo to mop up any stray cancer cells from the grade 3 tumour and then lastly a Mastectomy to deal with the DCIS.  which are just cells in situ not yet graded.  So I was hit with the 3 surgeries last year as with others on this forum.   
It is very overwhelming when getting bombarded with information we totally get it,as well as the very thought of having a boob off made me want to hide under the doona and never come out.  I did not get a reconstruction but many do have them straight away whereas others wait for 12 months or more.  Have you had an MRI yet.
There are many on here who have swapped over from private to public for the very reason you talk about so definitely worth looking into. I'm sure there are other lovely ladies here who can advise you on how they did it.   I found ultimately that we have to control what our gut feeling is telling us and arm ourselves with as much well informed information as we can. Have they mentioned Chemo at all. If they do IDC does respond well to chemo.  But just to reassure you I had great treatment on the public system and even my Oncologist is the director of Oncology so absolutely blessed. Wishing you all the best with your decisions.   Any questions at all just ask away.   This is the best place to have a rant and rave and some laughs along the way.  xo

@annie79 - I had lumpectomy, partial mastectomy and then full right sided mastectomy - I think surgeons do try for breast conserving surgery if possible.  

Gosh @annie79  - that is a tricky decision to make - shame she didn't get the margins the first time.   I am sure others who've had to go down that road will jump on with more advice to help you in your decision making. xx

Whereabouts are you?  City/town?  Some members are bound to know of other surgeons/resuources in the area that would be available to you .... you can swap between public & private.  I had private surgery & public rads & onc ...... Have you asked her if she DOES do public?  It may just mean a bit of a wait - if you really want her to do the 2nd surgery?

I was let down by my own health fund - I am about $6,000 out of pocket at this point .... so know how the financial side of things can affect you too  :(  

All the best - take care xx

Hi @annie79


Welcome lovely.  
I had lumpectomy followed by re excision for margins. They managed to get it all clear with a good cosmetic result.

 It's just a bit more of a widening where they have already been rather than another lumpectomy.......the lumps gone right?  Just needs a bit more breathing room.  It's far easier than the first one and normally you can be done and home on the same day.

It's your breast and your body so it's your decision nobody elses.

If your breast surgeon has admitting rights to the public hospital there is NO reason she cannot personally take you accross and do the surgery. I work at a public hospital and see it happen daily. There is normally minimal delay depending on theatre availability. 
There is a small private hospital just around the corner and it is a very common practice for a surgeon (most of ours work at both hospitals) to transfer a patient to public under their care if their insurance has run out or their are complications they won't cover.  Maybe just trying to get you to pay???? I would be sussing that one out a bit more. 

All the best sweet.
xoxoxox

@annie79 i ended up with having 2 lumpectomies because of unclear margins. I was invasive IDC stage 1 grade 2, no lymph node involvment. The overall size of the area, cancer and DCIS, after first surgery was 30mm. Another 15mm of DCIS was removed second time with clear margins. I went through Peter Mac in Melbourne as a private patient as my surgeon, whilst she offered to do it at a private hospital, distance wise it was not convenient and so she suggested Peter Mac where she is also based. I'd ask your surgeon if she works out of a public hospital, a lot of them do. If she does ask to swap over and be a private patient in a public hospital. We have not been out of pocket at all apart from the first couple of consults at my surgeon's private rooms. Since then all my appointments have been at Peter Mac seeing the same people every time just as if you were in the private system. 
Do your unclear margins have cancer cells or DCIS or both? Or is it that what margins your surgeon did take were too close to call? The pathology report would tell you this. You can always ask for a copy. They tend to prefer a 2mm clear margin of any cancer cells (dead or alive) or DCIS. It sounds like your surgeon thinks a mastectomy is not necessary ( which is good news) as she would ultimately prefer to conserve unless taking out too much is going to compromise the overall look. I was lucky cos i have D cup boobs so i had plenty left but someone with A or B size the outcome may be different depending on how much needs to be taken. I know when i asked my surgeon how much she was taking size wise the second time i was a bit shocked. She told me the area of two 50cent pieces, the actual thickness was probably only 2-3mm. She wasn't mucking around and i was glad of that. Whilst it's relatively easy for a surgeon to pick out the cancerous area because of the way it feels as it's a lump or a mass, DCIS is not as easy which is why they have to go back in another time. Ask heaps of questions, even if they sound silly! I know i did! Your med team are the ones who can inform you best. My situation with my husband was a bit different as he had prostate cancer at the same time so we were supporting each other through a pretty horrible time. It's a shitty time because your emotions are all over the place and you keep having to make decisions when all you want is for life to go back to some form of normality. 
There is light at the end of the tunnel...over 12 months on i am still clear of cancer, as is my husband and mentally in such a much better place. Be kind to yourself and whatever decision you make, make sure it's a well informed one and that you are happy with it.
Best of luck, lots of hugs, Cath xx

I had a mastectomy in November after a couple of weeks of indecision. I had a small tumour and DCIS which were a bit spread out.  Surgeon suggested an MRI so she had a better picture to get clear margins and glad I did as they found more DCIS so it was best to have the mastectomy to get it all.  Only issue was the MRI was over $700 but compared to 2 surgeries etc and all the out of pocket with private health insurance   Huge decision to make but in the end the MRI made it for me and I have no regrets knowing that all the cancer is gone.  Good luck

Hi annie. Sorry you had to join us.
The thing that struck me in your post is you say you dont want mastectomy and surgeon thinks it isnt necessary. I think you have the answer right there. Go with what feels right to you. Its ur body and its a huge decision . Once the breast is gone u cant get it back and it also isnt a 100% guarantee  .  Have you had an mri. As with kitkatb and julieVT above it was the only way the true extent of  my 7cm dcis was seen. I asked surgeon for referal for and was given a free mri in the public system  right at the initial diagnosis stage and saved the trauma of multiple lumpectomy surgeries. It was easier to accept mastectomy when there was no other alternative. They should do mri as a standard diagnostic test it shows a lot more detail  specially in younger women and others  with dense breasts. They dont do it routinely because it costs more. A lot of women on this site struggle to get free mri in public system.  Im not sure why my surgeon agreed to refer me  but luckily he did and  the follow up clinic i go to has also approved an mri every 12 months on my remaining breast so i know its possible. As you are young and trying to make this awful  choice you seem a perfect candidate for extra diagnostic testing. Good luck with it it really is a scarey and confusing time. Xx

Hi @annie79.  Before you take anything I say too seriously you need to know I'm a fully paid up cranky old cynic. I have, however, been on the cancer bus for a long time. So, with that in mind...

Your breast surgeon is only one of many. I don't like the sound of 'If you don't pay ME you may not get such a good result.' You have many other responsibilities and there are excellent practitioners in the public system. This shit can be insanely expensive through the private system. Which is fine, if you can afford it. That she is employing some form of emotional or financial blackmail on you at this stage gets all my bells ringing. Not just bells, claxons of alarm. You don't need that pressure at the moment and, if I am reading the situation correctly, you may be better off dealing with someone who puts your interests first.

Your husband is a different matter.  Some of our folk are really good at putting up links ( @SoldierCrab ) BCNA offers some excellent phone services which can help everyone concerned get their heads around the mess.

If it's any consolation, none of us are ever ready for this. You just have to take it a day at a time and do the best you can. In the end, it's your body and you get the final call. MXX

I think that you need to go with what you feel is right based on your surgeon's advice, although I can understand your husband's concern.  I am surprised that your surgeon can't take you as a public patient.  One thing I would ask, though - with the second lumpectomy, how much is going to be taken.  I had a wide excision first and was really happy with the result - was very hard to tell.  However, there were no clear margins on the path report so I had to go back for further surgery.  The surgeon said that he had taken as much the first time as he could with the result being that the breast still looked okay.  So, that was one of the reasons for going the full mastectomy.  That side is still flat as I am undecided about further surgery to reconstruct but he has done a really neat job - I'm guessing because there was enough room for him to do so.  My point is - ask what the resulting breast will look like as that may affect your decision.