My doctors is sugesting I have a mastectomy even though he said I had no cancer now, I dont know what to do...

Hi, I am 28 years old, have no family history of breast cancer. I found 1 lump just above my nipple on my left breast at the end of July this year, 3 days later I went to doctors, lady said it was nothing sinister and presumed it was a cyst, I asked to be referred to a specialist. About 2 week after the first lump I noticed another one not far from the first. 2 week later after I had been referred I went to see a specialist who said it was a Fibroadenoma and was again nothing sinister and that the second lump was just part of my rib, he asked that I came back and had a ultra sound, so on 20th of September 2010 I went for an ultrasound and was asked if they could take a needle test in my underarm nodes and a core biopsy from the 1st lump. On 30th of September I went back for my results and was diagnosed with Invasive ductal cancer, I had a mammogram and another ultrasound on that day. I was given 2 options...mastectomy or lumpectomy + samples from lymph nodes with radiotherapy. I opted for the second.

After the core biopsy I noticed that both lumps seemed slightly bigger, I was told it was swelling in the tissue caused by the biopsy. at my pro-op assesments I again mentioned about the 2nd lump..was told it was nothing, the doctor felt round my breast and I was still told there was just the 1 lump. I was also told that I would be having Chemotherapy due to my age, they advice everyone under 40 years old to have it.

On 27th of October I went for surgery, as I was down in the anaesthetics room, I again told doctor/surgeon about the 2nd lump at this time he could feel it, he was confused...he says it was not there before and I said it has been there all along, he says but its size must have increased, I say it was the size it is now when I saw him 3 week prior to surgery. Again I was given the option of mastectomy or removal of 1st lump and tissue arround it, removal of 2nd lump with no tissue taken arround it and samples from 3 of my lymph nodes. The doctor is confused... the mammogram and ultrasound that I had, had never showed the 2nd lump.

On Friday 12th of November, I went to see doctor/surgeon for results and plan what is next... I go with hope of good news and to be told when chemotherapy and radiotherapy starts. My lymph nodes came back clear..that I was happy to hear. the 2nd lump was cancer aswell. he the sugests how I should have a Mastectomy and then reconstruction. I then ask..is it because when you took 2nd lump you didnt take extra tissue like you did with first..he says no... I then ask so there is no cancerous tissue?... he says No..I say so I dont not have cancer now...he replies No. I ask why do I have to have a mastectomy if i do not have cancer now, he says it is due to the distance between the lumps, holding his fingers up he shows about 6-7cms, I say no it was about 1 and a half cms..he does not say yes or no to what I say.

If the decision of a mastectomy is based on the distance of them lumps, then to me it is a fail... they have no proof of the distance as it never showed in any scan, there is only the doctor and my opinion on the distance. he says there is a risk it could come back due to there being 2 lumps and the distance, both lumps were contained, which I am guessing means that lump 1 did not spread to then make lump 2.

There are so many questions I have, I can not help but feel that this is a very drastic precaution, if I do not have cancer now. He wanted me to decide there and then on the mastectomy and reconstruction, I could not do that... my head is a mess at the best of times so this is all to much for me, I wasnt normal before hand, I've never been good at making decisions, I've had depression for 13 years..anxiety for about 5, so much has happened in the last 13 years that this was the last thing I expected. I have no clue what to do...I know I need more facts, need to know why my doctor wants this. He said he would send the breast care nurse to see me to talk more, but in my opinion, she will come and just try to push me into what the doctor is sugestiing rather then give me any facts.No one in my family or friends can understand why he has sugested it if I have no cancer now.

I would be very greatfull if anyone could give there opinions or sugestions.

[gorditana]

Dear Illyria101,

I went and search in the website called www.breastcancer.about.com and this is what came, it may not answer your question entirely but I thought is useful information that you may read and think about your options.  All the best to you!

Question: Should I have a mastectomy or a lumpectomy for early-stage breast cancer?
Your first treatment decision is often about surgery. Before the 1970s, a mastectomy was the only surgery for for any stage of breast cancer. Since then, less invasive techniques have been developed, and imaging technology has greatly aided surgical accuracy. Patients have become more involved in treatment decisions and better informed of choices.
Still, deciding on a surgery for breast cancer is often difficult. Your goal is to remove as much cancer as possible, and prevent a recurrence. Let’s look at your options and some statistics about lumpectomy and mastectomy for early-stage breast cancer.

Answer:
If you have early-stage breast cancer (DCIS or Stage I, IIA, IIB, or IIIA), you may have a choice between breast-conserving surgery (lumpectomy) and removing the breast (mastectomy).

Women and Early-Stage Breast Cancer

It's normal to worry about how long you will live after surgery and treatment, or the chances of recurrence. These are practical questions to consider. The National Cancer Institute says that early-stage breast cancer patients who choose lumpectomy and radiation will live as long as women who opt for a mastectomy -- whether or not they also choose to have reconstruction. Your odds for recurrence of early-stage breast cancer are around 10% (1 in 10) within 12 years of lumpectomy and radiation. If you have a mastectomy, your risk of recurrence is about 5% (1 in 20) on the same side within 12 years of surgery; that risk is the same regardless of reconstruction surgery. You may also consider having chemotherapy, targeted biological therapy and hormone therapy to increase your chances of long-term survival.

Male Breast Cancer (MBC)

For early-stage male breast cancer, a mastectomy is recommended, because there usually is not enough breast tissue for a lumpectomy. Lymph nodes will be sampled to determine whether or not the cancer has spread beyond the breast. Radiation, chemotherapy and hormonal therapy may also be needed, depending on the type, extent and location of the cancer.

Considering Your Surgery Choices

Get help for making your breast cancer surgery decision by talking to your oncologist and surgeon. Try this list of 10 questions to help you sort out your feelings and options. If you have early-stage breast cancer and are not offered at least two options, go to a different doctor and get a second opinion. Ask about survival statistics based on your diagnosis, and about your surgeon's expertise in breast cancer surgery procedures. Sometimes your health insurance may limit your choices, but if you want more options, ask how you can work out a financial compromise. If you're favoring a mastectomy, you should also be discussing your choice of breast reconstruction methods. If breast reconstruction is not mentioned before you settle on a mastectomy, consult a plastic surgeon to see what your options may be. Make sure you feel as confident as possible when you choose your breast cancer surgery procedure.

[Cheerpul]

I think that you should definitely talk to the breast care nurse.  From what you have written, you had 2 separate lumps that were both cancer.  You have not listed the characteristics, such as estrogen and progresterone positive or negative, Her2 positive or negative, family history, BRCA gene status, the size of the tumors, the grade or stage of the cancer that are important factors to consider when you make your treatment plan.

Because you have no cancer that can be detected right now, does not mean that there are no cancer cells in your body.  The purpose of radiation, a mastectomy and/or chemotherapy is to remove or kill any additional cancer cells.  If your tumors are hormone receptive (estrogen and/or progesterone positive) you would be a candidate for hormone therapy, most likely, tamoxifen.  If your tumors are Her2 positive, you would be a candidate for Herceptin therapy, which blocks the Her2 gene from acting.  (The Her2 gene makes cancer more aggressive and likely to spread.)  Since you are young, your doctors are suggesting more aggressive treatment for a couple of reasons:  You have a long lifespan ahead and they want to do what they can to keep the cancer from coming back and often breast cancer in younger patients is a more aggressive type than seen in more elderly patients.  Premenopausal ladies have more estrogen in their systems which often fuels tumor development.

Treating cancer when you are first diagnosed  has more success than if it comes back.  Often, it has spread to other parts of the body and cannot be cured at the second appearance.  That is another reason your doctor is advising a mastectomy.  He is looking at your best chances with current treatments for a long-term cure.

You may want to call the local American Cancer Society and ask for information and maybe a visit from someone through the Reach to Recovery program.  These volunteers are people like me, who have had breast cancer and can help you sort out and understand your situation.  When you talk to the nurses and doctors, have a friend or relative along to help you take notes and remember the questions you want to ask, (which I write down, so I don't forget.)

A mastectomy seems very drastic, but cancer is much moreso.  I had a mastectomy a little over a year ago for invasive breast cancer.  I took chemo, (taxotere, carboplatin and Herceptin) and have continued the Herceptin through this month, when my last treatment is scheduled.  I am then going to have the second mastectomy, as a preventative measure in Dec.  The percentage of breast tissue that is removed reduces your chances of reoccurance of breast cancer by the same percentage.  So, a mastectomy that removes 90-95% of breast tissue, reduces your chance of breast cancer by 90-95% in that breast.  Breast cancer can spread elsewhere, that's why you have radiation and/or chemo to reduce that risk even after lumectomy or a mastectomy.

You should explore reconstruction options.  Get advice from people who know on the best plastic surgeons that you can find who do this.  The are many surgeons who get wonderful results and allow you to consider a mastectomy with resonstruction probably after adjunctive treatment, as an alternative that allows you to retain a bosom.  I am 48, and had small breasts to begin with and have a fabulous surgeon who made a very subtle, thin pink line as my mastectomy scar after one year.  I have opted not to have reconstruction.  

A cancer diagnosis is shocking, especially when you have struggled with anxiety.  Being confused and upset right now is normal.  To move forward, try to focus on facts, ask questions until you understand your lab reports, diagnoses, treatment options and so forth.  If you have trouble verbalizing questions, choose a person to accompany you to appointments who can help you to stay calm and take notes to go over later.  Don't worry about "what-ifs."  (Most of them don't happen, but they eat up your energy with unproductive worry.)  Take your tests and results step by step and see what they reveal.  Talk to your doctors and nurses (They really are concerned about you.) and ask what are their opinions, and more importantly, what their thought process was to arrive at their decisions.  This process can help you make decisions based on facts and logic and help lessen your anxiety.

You can always ask questions here and we will support you however we can, but your doctors have all of your details and can offer the most information.  I am thinking of you.

[todd30]

Boobs are over rated. Your health is everything! Better to be safe then sorry. Good luck.

[SueYoung55]

To have breast cancer at a young age like yours is not common. Have you had genetic testing done to find out your BRCA status? I think you should do that because you should take in all the information before you make your decision.

My original lump on ultrasound was 1.5 cm but the MRI showed it was really 10 cm. That took me from having early stage cancer to having stage 3 cancer. At the time of my first mastectomy there were also two nodes involved. I've since had the other removed as well for peace of mind. I chose DIEP flap reconstruction and am happy with my choices.

You've already had breast cancer. With mastectomy and immediate reconstruction, you remove almost all of the breast tissue and therefore lower your risk of recurrence. Something to think about.

Best wishes.

[alidi]

Hi:
I am not a doctor , I am not intending to do a diagnosis or prognosis
on your case, but it seems,to me you MUST see a good Oncologist-Surgeon.
What is that? your doctor is not SURE of?
Did he do an Onco-Test, what is the #?
Did he do Sentinel Nodes, are they Negative,?
Do not worry, you will be fine, just keep yourself informed .
Have regular check-ups by a good Onco.

Chemo? OH NO!!!