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Breast Cancer (Expert Forum)
Is a mastectomy a possibility?
Questions posted in the Breast Cancer Forum are answered by medical professionals from The Cleveland Clinic. Topics include Breast Biopsy, Chemotherapy, Hormone Therapy, Lumps, Lumpectomy, Lymph node dissection, Lymphedema, Mammograms, Mastectomy, Radiation Therapy, Reconstruction, Self Breast Exam, and Surgery.
Is a mastectomy a possibility?
by Kathy Q, Mar 07, 2004 12:00AM
Hi, I had a localized needle biopsy, a re-excision and I’m scheduled to go in for another re-excision since the last one had some DCIS cells which the pathology report indicated might be .35mm outside the margin. The language on the path report was kind of vague regarding whether or not the cells were inside or outside the margin. If they don’t get a clear margin with this next procedure will they be likely to recommend radiation or a mastectomy? Although I think both my surgeon and radiologist may have indicated this as a possibility my ability to absorb information has been severely impacted by all that I’ve had to absorb during the last month. I looked at the American Cancer Society website section on making treatment decisions and a mastectomy seems to be one of the options if you don’t get clear margins. I posted a few days ago and included my diagnoses so far in that post. A mastectomy was the furthest thing from my mind when I was first diagnosed. I’m trying to figure out if I should be considering it as one of the possible outcomes. All the cancer detected so far (which is very, very little), is DCIS, non-invasive, hormone receptive. Thanks in advance. This is a wonderful place to get helpful information.
Kathy Q
Kathy Q
Doctor's Answer
by CCF-RN,MSN-rf, Mar 08, 2004 12:00AM
Dear Kathy Q: If the margins are positive, meaning that there are cells within 1mm of the sliced edge, then more definitive treatment would likely be recommended. Likely, the recommendation will be mastectomy - no radiation needed if all is DCIS. Mastectomy is recommended for DCIS when it is multifocal (has more than one focus), involves a lot of breast tissue (such that a lumpectomy will be disfiguring), or is the choice of the patient. If mastectomy is the recommended treatment, you may wish to meet with a plastic surgeon to discuss reconstruction options.
Member Comments (2)
by surgeon, Mar 07, 2004 12:00AM
the report of a biopsy can only tell whether cancer is at or within the margins; it can't say what's beyond the margins, since the margins are the edge of what's removed. Mastectomy is definately a consideration when clear margins can't be obtained; what's at issue, really, is the amount of tissue removal required to get to clear margins, compared to what's left. If the amount needing removal is such that the shape of the breast would be significantly affected, then the main advantage of breast preservation -- appearance (without needing reconstruction) -- would be lost.
