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What are you thoughts on Subcutaneous Mastectomy for DCIS

In September I was diagnosed with DCIS Lt breast.3mm focus of Ductal carcinaoma in-situ solid type, nuclear grade 2 minimal necrosis present 4mm from nearest margin of excision.Mild to moderate hyperplasia, variable ductal chronic inflammation with reactive changes.
My paternal grandmother and her sister had breast cancer.Neither of them had daughters, so I am the next generation of female.
Last August I had total hysterectomy with appendectomy due to severe bleeding.

My Dr. suggest breast conserving surgery with radiation. I am thinking more of subcutaneous mastectomy (leaving nipple complex intact.
My surgery is scheduled for Oct 30th and I am starting to panic a bit.

Thanks
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Avatar universal
I was diagnosied with DCIS in May of 2002. I had a complete double Mastectomy, I had read that if you had breast cancer in one breast statically you had a higher chance of getting invasive cancer in the other breast. I don't regret my decision at all, mainly because I don't worry as much about getting cancer in other breast. I feel like I went above and beyond on my treatment I did not have to have radiation or chemo and since I had a double mastectomy I don't take Tamoxifin. Do you think I should have had radiation or chemo or take Tamoxifin? By the way I was diagnosied at age 38, by having a mammogram at 34 36 and 38 the only way they caught it was because they had one to compare it too. God was with me!
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Avatar universal
Nothing seems to have a clear distinct answer.Can anyone tell me what the clean margins are for DCIS?

Could the Atypical Hyperplasia have been misdiagnosed as DCIS?


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I agree, you are very much appreciated.Your advise and expertise means alot, even when I don't agree with you....Tessa
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Your answers, in conjuction with the forum moderators professional advice, is appreciated by all..
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Avatar universal
true enough: although one might derive some sense of the difference between "guerilla" and "surgeon." I happen to be the latter; have been a surgeon who has dealt with breast cancer more than any other entity in my practice, which began in 1977. I have lectured on breast cancer. I've cared for a few thousand women with breast problems. I'm sure there are some who would consider my opinions just "wind." The fact is that in the final analysis, any health care decision must be made between the person and her/his provider, after the person has gained enough information from whatever and however many sources and resources it takes to be comfortable. It's not wise to proceed before coming to a level of comfort with one's choice of treatment and the provider thereof. And the best way to get there, finally, is by having thorough discussions face to face with one's chosen care providers.
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Avatar universal
Jojo, Just get second, even a third opinion if you are not comfortable. A forum like this may help you kick things around in your head, but since you do not know the background of posters other than those on Cleveland staff, I would not view my, or any other poster's, comments as anything more than wind, regardless of their nickname. This breast business is confusing enough. I will be thinking of you.
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sorry, but DCIS is indeed cancer. It's not invasive cancer, meaning it hasn't yet gotten to the point where it can spread beyond the breast, which is why it's considered nearly 100% curable. But it's not totally 100%, for several possible reasons: even if invasive cancer is not found in the area of DCIS, it's possible it's there, since not every cell can be looked at. And it's also possible that there could be invasive cancer elsewhere in the breast, especially nearby. Which is why for many cases of DCIS, treatment of the entire breast is recommended. The perfect way to predict who needs what has not yet been discovered: but there are differences in appearance of various forms of DCIS, some of which ("comedo" variety, for example) have been associated with higher risk of recurrance, and in need of more aggressive treatment. And if DCIS recurs, it has a higher chance of doing so with an invasive component, so the initial treatment choice is important.
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Avatar universal
Apologies for not addressing the mastectomy question. For DCIS, which is NOT cancer, I'd be hard-pressed (myself), to have my breasts removed.
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Avatar universal
Every woman must decide what course of action is best for her. But much better, as you know, if this decision is based on peaceful self-inquiry, rather than fear. The breast can only be radiated once. I have had malignant cells in my breast. I also have DCIS and LCIS. With all too much regularity, I'll have a day when I lose touch with my 'knowing' self, and simply freak out. I try never to decide ANYTHING until this passes. I did not have radiation. I did not have chemo. I did not even have passable margins upon excisional biopsy. Go figure. Might I suggest that you have your slides sent to another pathologist for review? I had mine sent to Dr. David Page at Vanderbilt University. Cleaveland could probably do it too. At least this way, you'll have back-up on the diagnosis, and have a tad more time. I also assume you have researched DCIS in Dr. Susan Love's breast book, and/or Susun Weed's 'Breast Cancer? Breast Health', regarding DCIS. PS Don't feel you have to be 'a nice girl'in any of this.
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Avatar universal
Dear jojo:  If I am understanding what you have written, all of the DCIS is removed with 4mm margins?  If this is the case, I am confused as to why you are having additional surgery (of course you might still need radiation therapy).  However, if I have misunderstood, and you do need more surgery, then, technically you could have lumpectomy with or without radiation or you could have a mastectomy (although for one focus of DCIS this is the more aggressive approach).  Nipple sparing surgery is fairly new but early results are promising when patients are selected appropriately.  The tissue of concern must not be located near the nipple.  For this small focus of DCIS, without and invasion, it is probably a viable option.  Good luck in your decision.
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Avatar universal
My oncologist and surgeon recommend wide section excision, followed by radiation.What are the margins required to feel safe with this ? I was under the impression it was 3CM.
Do you think I am being overly cautious since it is DCIS?
Also do you think the endometrial atypia( diagnosed from Hysterectomy) and atypical calcification in the breast are somehow related?

Thanks, I really appreciate you thoughts on this.
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Avatar universal
the cure rate from what you have is close to 100%: the only question is how much treatment is necessary, how much is too much. For some women, removing the area with no further treatment at all would suffice; for others, the whole breast needs treatment. We don't at the present time have a way to distinguish among the groups. The data suggest that your version would be equally well treated with radiation or mastectomy, and the choice is really based on your personal preference rather than success-rate. The one caution is that if one chooses mastectomy, there is reason to have the nipple removed as well, since it contains ductal tissue that either could harbor cancer cells, or form them in the future. The risk of that is low, although there's no way at the present to tell who would risk recurrance and who wouldn't. So I have advised women who prefer mastectomy for DCIS to have complete mastectomy. Not everyone agrees. And I'm not the "official" answerer here; you'll get one of those, too.
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