Totally confused after seeking second opinion

Oh Gingin it is so hard! I was told if my tumour was >2cm on MRI I would have chemo first before lumpectomy. I had a 1.8 cm grade 2 stage 1 LC. I was operated in Melbourne 

Ask surgeon B if they will need to do a mastectomy if he does not have clear margins. I had neoadjuvant and the tumours shrunk to virtually nothing BUT I went ahead with the mastectomy anyway as I had a haze of cancer right across the top half of my breast additionally to three tumours so a lumpectomy was never an option. Chemo isn’t fun so both options have both negatives and positives. Sorry, not much help. 

Grade 3 is rapidly aggressive growth and more likely needing chemo treatment but not sure before or after surgery. What's your likelihood of returning? Ask if they have that pathology now or if that will be available after surgery. It is another factor for your consideration. I would be concerned about reducing that likelihood too as well as addressing that grade 3 cell. Good luck.

I’d definitely opt for surgeon B. Definitely. Sounds like he’s genuinely interested in getting rid of the cancer in the quickest and safest way possible for you, not to mention cheaper. Just my thoughts. 

@GinGin - what a shame they didn't both have the same opinion! grrr  It just mucks with your brain a bit more than it already has!  xx  It is a very personal decision that only you can make - but it really is about the 'what ifs' ...... ie What if I get a recurrence ..... did I make the right treatment decision?  

Have you considered joining the Breast Reconstruction Group, or Flat Chat (about possibly choosing no reconstruction) - you'll be able to chat with others who may have had to make the same decision?

I was lucky & just had a lumpectomy, rads & tabs - but I was fully prepared for them to go ahead with mastectomy once they started the surgery, if they thought it warranted it, as sometimes the size of the tumour 'on the screen' can be smaller than the actual size of it, once in surgery.

Quite a few cancers have chemo prior to surgery, to manipulate it & hopefully make it smaller, which may mean less aggressive surgery is required ... 

It sounds like Surgeon A is throwing everything at it, to give you (as he sees it) the best outcome possible and his 2nd option goes for the bigger surgery but without the chemo first .....  tho Surgeon B seems quite convinced the earlier chemo isn't required ....  ay yi yi

I think my question to both of them would be: What would you recommend your wife/daughter if it was their biopsy results, for their best possible outcome?

Have either of them mentioned a Sentinel Node Test being done? (mine was done prior to surgery [and was clear] to see if the nodes closest to the breast have been infiltrated by the cancer at all) - as this will also give them even more information to work with re the level of surgery/chemo requirement ...   
Hmmm, Some sites indicate that Stage 3 may have already infiltrated the nodes ..... which means it may also have escaped into the body already - which means, maybe throw the kitchen sink at it!?

As @Cath62 said - it is the aggressiveness and size of the tumour that normally dictates the amount of surgery & need for chemo before and/or after surgery (or not at all.)  

Can you talk to your Breast Care Nurse about it?  She may be able to put unbiased opinions/explanations to help you in your decision making xx

take care & all the best xx

This is one of the problems with options - unless you are virtually a qualified oncologist, you are not in the best position to choose! I have been grateful I didn’t have to, my surgeon was clear about what was required, the only choice to make was a full mastectomy or partial and half a boob didn’t seem like any real benefit! 

Given a general move towards chemo first, I’d align somewhat with Surgeon A. If chemo significantly reduces the tumour, a lumpectomy is more likely to be the option and remove all the cancer (the latter is the cruncher). While no-one wants chemo or a mastectomy, more than a decade of a happy life with (touch wood) no sign of recurrence tells me that chemo was worthwhile. It’s sometimes nowhere near as bad as it sounds, and there are better ways now of avoiding some side effects. Best wishes. 

Hi @GinGin
Problem with any advice we give is that we are all different and none of us are oncologists.
My decision was pretty easy - I had a 5.5 cm lobular ER positive cancer and my breast cancer surgeon ( who is very experienced) said lobular cancer was notorious for being more extensive than shown in the MRI.
He also said that if he did a lumpectomy and didn’t get clear margins he would have to do a mastectomy anyway.
I went with his recommendation of a mastectomy and had reconstructive surgery ( my story and photos are in the private  group “ Choosing Breast Reconstruction”.)
No one said this was easy .
Take care 🌺

Hi, have you considered gene activity testing, if you're ER+ & Her- it can help determine if chemo is necessary..  I'm no expert,  that's just some tid bit I came across in my own research,,  im ER- & HER + 

Ok im still learning myself, so please forgive my silly question 😁 isn't HER neg the slowest growing grade, so can't be  grade 3 ? 
HER pos is the high grade,3 fast growing ? 
OMG IST SO CONFUSING 😃😳

My understanding is that the grade relates to how abnormal the cells look like under a microscope,  compared to normal cells. The Estrogen, progesterone and Herceptin status, ie pos or neg, relates to if the cancer cells have receptors for 1 or more of those hormones which help it survive and thrive.