Monday, October 13, 2008 AZ asks

Q: should i forget about clearing my margin and have a mastectomy instead?

hi, i am 48 years old with very dense breast and my sister was dx 2 years ago with at age of 55.

9-15-2008, my biopsy came back with infiltrating mammary carcinoma of mixed histologic subtypes with both ductal and lobular features.

10-06, i had a lumpectomy and nodes removed.

-Pathology report-

Histopathologic type: idc and extensive dcis component.

Histopathologic grade(bloom-richardson,l-lll): ll/lll for the infiltrating carcinoma.

Nuclear grade: 2/3 for the infiltrating ductal carcinoma

Mitotic rate: 1-10/10 hpf.

Lymphoplsmacytic response: no

Extensive intraductal carcinoma (>25% of tumor): yes. most of the neoplasm consists of in situ carcinoma predominantly intermediate grade with predominantly solid growth and with largest individual area involved by the in situ ductal carcinoma measuring up to 1.2cm.

Pathologic tnm stage: T1a, NOsn, MX

Ancillary studies: er+/pr+

i didn't clear the 6:00 o'clock margin and have scheduled for re-excision on 10-22. i will see my surgeon tomorrow for my follow up.

also, my 6:00 o'clock diagnosis - up to 4.0 mm focus of infiltrating ductal carcinoma grade ll/ll extending to the green inked margin and multifocal in situ ductal carcinoma low and intermediate grade approaching the green inked margin and fibroadenoma.

with all this info i'm not sure if i should worry about clearing the six o'clock and have a mastectomy? will my options with a mastectomy be limited with my weight being 100 lbs.

thank you, any input will be greatly appreciated.

Answers (1)

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PJ Hamel

10/13/08 10:25pm

Hi - tough decision, and only you can make it. If you have a mastectomy, then you obviously greatly reduce the risk of breast cancer coming back in the same breast. I can't read a patholgy report very well - can't tell if there was node involvement. If not, then a mastectomy would also help preclude cancer spreading to other parts of your body. A lumpectomy, while less sure, when accompanied by radiation also does a good job. They are EQUALLY EFFECTIVE for preventing death due to breast cancer.

You'll have to decide how much of a risk-taker you are. Do you feel you could take a chance with a lumpectomy? Or do you feel you need to go for a more aggressive mastectomy, which comes with other physical problems (possible shoulder issues, numbness, body image, etc.)? If you're very small-breasted, you might actually have a better result with mastectomy and a prosthesis, implant, or possible reconstruction. Depending on how much more they have to take with the lumpectomy, they might leave you with a disfigured breast.

All of that said - personally, I opted for the lumpectomy. In the end they couldn't get clean margins, and I had a masdtectomy and reconstruction. But I felt the less aggressive surgery was worth a chance, at least.

Good luck with your decision - PJH

Q: should i forget about clearing my margin and have a mastectomy instead?

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