Bilateral mastectomy

[Prettyangelface]

A little about me... I am 28 yrs old, mother of 2 and have just been diagnosed with Invasive Ductal Carcinoma. Last week I had a lumpectomy with sentinal node biopsy that showed 2/6 lymph nodes positive and unclean margins. The tumor was 4.4 at its largest diameter. It was thought to be much smaller, that is why they only did a lumpectomy. Now the surgeon is recommending a bilateral mastectomy because the cancer is very agressive:
Nuclear grade 3, nottingham grade 8/9, necrosis present, comedo and solid. ER 92% and PR 17%, Her2 negative, KI67-35%, unfavorable and P53-7 %, favorable.
My bone scan came back normal and I am awaiting the results of the PET scan. I keep hearing over and over that my cancer is of the very agressive kind so I'm worried whether I should be receiving chemo FIRST instead of having surgery. Should I just have the mastectomy first?? I am hearing different opinions on the matter. My biggest fear is if I wait for chemo, will the cancer spread into my lymph nodes and then metastasize into my body.
Anyone else with a similar situation? What did you do? How should I proceed? I have already spoken to several drs, they all seem to recommend a mastectomy first then wait 6-8 weeks for chemo.

[jenca78]

My stepmom was diagnosed with breast cancer on Valentine's Day, February 14, 2008.  Over the course of biopsies, ultrasounds, MRI, etc, we found out that the cancer is hormone receptor positive and HER-2 negative, and the tumor (in her right breast) was about 1-2cm in size, which they consider to be small.

She was given two choices - lumpectomy followed by radiation, or mastectomy.  She came to the decision to proceed with a bilateral mastectomy, with the left breast being profylactic.  She decided on that because of family history, and not wanting to live in fear that she hadn't done enough.  She had full 100% support from us, and from her doctors.  She had the surgery on April 15, and is doing quite well now, which is two weeks later.  The pathology came back all clear, but she does not at all regret the decision.

It really is a personal choice, but my stepmom made that choice because she didn't want to live in fear, or regret not doing enough....I wholeheartedly agreed with her decision, but wonder if I would have the guts to do it if it was me.  It really depends on your perspective, and I wish you the best of luck as you come to the decision that is right for you.  I offered this story as just another perspective.  

[PaulMD]

Hi there.

In understand your concern.  There is a new study that just came out last year that involved breast MRI.  It showed that the MRI can demonstrate a hidden cancer in the other seemingly normal breast about 10% of the time, concurrently with the present tumor on the affected breast.  I suggest you discuss this option first with your surgeon before proceeding with removing the other breast.  A not so good margin on the lumpectomy may be treated with re-excision of a larger tissue to obtain negative margins.  If the tissue to be removed is quite large and salvaging the breast is not possible, then it may be reasonable to have a mastectomy as well.  For sure you will need post-operative chemotherapy and even radiation therapy to decrease the risk of recurrence and cancer spread.  Regards and God bless...