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Thursday, September 03, 2009 Confused, Community Member, asks

Q: Second lumpectomy possible for new cancer diagnosis on same side?

First cancer - age 33, infiltrating ductal, triple negative, 1 positive lymph node.  Treated with lumpectomy/axillary node dissection, chemotherapy and radiation.


Second cancer - age 42, infiltrating ductal, est/proj positive, HER2 negative.


Mastectomy (possible double) recommended for obvious reasons but I am paralyzed at making such a huge decision.  I am also not excited about my reconstruction options as I am not a candidate for a tram flap, must go with implants.


Would it be foolish to consider a second lumpectomy followed by chemo?  Since breast cancer is such a high profile disease with much research and advances taking place I keep thinking that maybe in a few years there would be better treatment methods rendering a mastectomy unnecessary.  A mastectomy is forever and I just don't know what to do.....

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Answers (1)
PJ Hamel, Health Guide
9/ 3/09 3:08pm

Hi -  Since it's not triple negative, it seems it's a new cancer, not a recurrence. Sounds like you might just have some bad luck, with two separate cancers.


I'm with you - I'd think long and very hard about a double mastectomy. If it's the same breast, then I'd be more prone to have a single mastectomy of that breast. Though if it's very small, with no lymph nodes involved, you might try a lumpectomy first, see if they get good margins. As you say, you can always go back and take more - you can't go back and take less. And new treatments are on the horizon all the time.


I'd ask the doctors to explain specifically why they think a double mastectomy is called for. That would definitely lower your risk of recurrence, but it wouldn't raise your 5-year survival rate. And it's quite aggressive surgery, esp. if you're not pleased with your reconstruction options.


I'm no doctor, and this is strictly opinion, but I think my decision would be between lumpectomy and single mastectomy. Readers, can you chime in here, please? Thanks - PJH

Confused, Community Member
9/ 3/09 4:29pm

Thanks so much for your quick response.


I apologize, I'm afraid I wasn't very clear in my original doctors aren't necessarily recommending a double mastectomy, it was just mentioned to me as an option I may want to consider as I have had two different cancers at a relatively young age.  They are however recommending a single mastectomy (I should mention I have had a second opinion with basically the same result).  Apparently this is the standard of care at this time.  I understand what doctors try to do is provide the best treatment option to limit the chance of recurrence, but I just can't help thinking "why can't we try lumpectomy first?"  Having said that, however, I don't want to try that if it means potential further risk to my health.  I am actually waiting for a call back from doctor to ask about this.


As I said, I've seen several doctors, I"ve read the cancer websites, read a couple books, checked out some chat other words, done all the things you're "supposed" to do to educate yourself and make the best decision "for you."  My problem is, what if on paper you've done all the right things and still don't know what's "right for you?"   Sigh......(scream, cry, panic, etc....)  : )

PJ Hamel, Health Guide
9/ 3/09 8:43pm

Ah - OK, now I get it. You know, one of the most important things I've learned in life is this: absolutely no "woulda, coulda, shoulda." Make your decision and NEVER LOOK BACK. I know, the issue is actually pulling the trigger on that decision - how do you arrive at that place that what you're doing feels right?


I usually advise women, YOU know your personality. if you're someone who does second-guess, and worry, and bombard yourself with "what ifs," then you should probably have the mastectomy. If you're less of a worrier, more of a "take life as it comes" type of person, then have the lumpectomy and hope for the best. Hope for the best - expect the best - be prepared for the worst (just in case).


Does your hospital have a shared decision making office, by any chance? I had to decide between lumpecotmy and mastectomy, and our hospital's Center for Shared Decision Making was very helpful.


Only you can make this decision - because you're the one who'll live with it. There's no right or wrong - just what your heart tells you. So sit quietly, clear your mind, and look deep, deep inside. I think at the end of the day, when all the research and outside advice is done, you'll find the answer there in your heart.


Good luck to you - PJH

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By Confused, Community Member— Last Modified: 12/27/10, First Published: 09/03/09