Lumpectomy vs. Mastectomy for the Newly Diagnosed and Confused?

[ND-5808]

I've just been diagnosed with infiltrating ductal cancer in the left breast, with four tumors found in an MRI, of 8 mm, 4mm, and two "satellites" of 3 mm each. Core biopsy of the 8mm and 4mm tumors found Her2new-pos, estrogen negative cancer.  I have a strong family history of breast cancer (no ovarian), and will get results of genetic testing around Jan 20.  The first surgeon I talked to recommnded mastectomy in the left breast -- and even raised question of prophylatic mastectomy of right-- almost immediately.  I am having a different surgeon do the surgery (for other reasons, not b/c I objected to the recommended course), but I more or less assumed mastectomy from the beginning, and now just wnt to be sure that it is a good call.  One thing I worry about is that I am opting for mastectomy for emotional reasons -- to feel I am taking more drastic action more likely to prevent recurrency-- when in fact the studies show that, all other things being equal, lumpectomy with radiation yields similar survival rates to mastectomy. Bottom line: I don't mind losing all of my left breast rather than part of it if its for good reasons, but don't want to do it for nonrational reasons!!!  So, my question: given my situation (multiple although small tumors, Her2new pos, estr/prog-neg, and strong family history, B-cup size), are there good survival-related reasons for going for the mastectomy?  Thanks so much!

[rkmsim]

With the strong family history and multiple tumors I would opt for the mastectomy.  I am BRCA1+ and had bc in 1998 on the left side and a new primary in 2003 on the right side.  I didn't know about the BRCA1 status until 2004 so had the bilateral mastectomy done at that time.  If you can get the genetic results before surgery and find out that you are BRCA positive, you might want to seriously consider the bilateral mastectomy as you would be at high risk for bc on the other side. With the mastectomies and oopherectomy in 2004, I've greatly reduced the chance of a recurrence or new cancer, but of course, the risk will always be there.

I feel compelled to comment on one of the other replies that stated a surgeon guaranteed 100% that a recurrence wouldn't occur for the woman if she had the mastectomy.  Such a statement is reckless and isn't fair to the woman.  While the mastectomy in her case may have drastically reduced the chance of a recurrence, no doctor can make a 100% guarantee that it will not recur. Breast cancer can never be considered cured and recurrence can occur years later.  Not something we like to think about but the facts nevertheless.  To be less than honest with a patient is not fair to that patient.

[ellabella]

I was diagnosed with invasive ductal stage 2 (also multi focal) almost three years ago.  My surgeon recommended bilateral mastectomy and I chose to have a bilateral mastectomy.  I too have a strong family history of BC.  I had no lymph nodes positive, but have recently found a lump in my non cancer breast.  I am going to have a biopsy.  Even though I had bilateral mastectomy the fear of mets is always there.  I too was HER2Nu+ ER/PR -.  I was negative for the BRCA1 & BRCA2 which amazed all of my dr's.  As of now you don't know if you have lymph node involvment and that may make a big difference in whether you choose mastectomy in only one breast or both.  I agree with the previous comments that in your case mastectomy would be a better choice considering multifocal and HER2Nu.  I wish you luck in whatever you choose.

[calebs mom]

I was diagnosed with breast cancer last March 2005.  Invasive DCIS, Estrogen/Progesterone Positive.  My surgeon said I was an excellent candidate for a lumpectomy, but I chose to have the mastectomy because he could gaurantee 100% that I wouldn't get a reocurrence.  It's a good thing that I did have the mastectomy because after the breast tissue went to the pathologist, they found more cancer that was too small to show on the ultrasound.  They would have had to go back in again for more surgery later.

I had immediate reconstructive surgury and am very happy with the results.

It's scary, but do lots of reading and asking others that have gone through this.

By the way, I was 49 at the time and I myself had to problem getting the breast removed.  My sister-in-law went through the same thing 9 months before me and had both breasts removed.

Good luck.

[xrayu2]

If it were me, I would choose mastectomy over lumpectomy.  I watch women with lumpectomies come with such fear every 6 mths to have their mammo repeated.  While you still have the other breast to deal with, you wouldn't have the issue of the radiologist saying "? scar tissue verses recurrence" and having to drag you back for extra views.  Of course the choice is ultimately yours and I am just giving an opinion.  I wish you well.

[ND-5808]

Hey -- I'm ND-5808. Forgot to say I am 48, and still menstruating, but erratically.

[CCF-RN,MSN-rf]

Dear ND-5808:  In situations of multifocal disease, a mastectomy is often preferred over lumpectomies for two reasons.  One is assurance that all cancer has been removed.  The second reason is cosmetic.  The more tissue that needs to be removed, the more likely the cosmetic result will be compromised.  Without reviewing your breast imaging and an examination, it is impossible to make recommendations for your specific case. A surgeon with expertise in breast cancer would be best suited to advise you of the most appropriate course or options for you situation.