surgery question

[jen109]

Hello,

I'm waiting on a definitive diagnosis from a breast biopsy.  The biopsy came back fine, but one of the doctors I saw recommended having surgical excision to be sure.  Another doctor felt this wasn't warranted since the biopsy (done by fine needle) came back benign.  Do people with benign biopsies by fine needle usually not follow up with surgery to confirm diagnosis?

Also, I'm scheduled for surgery very soon on my ovary to remove a suspected endometrioma.  Is it safe to have surgery to another part of my body before having a confirmed diagnosis for my breast.  If there was any breast cancer present, is it risky to have surgery somehwere else in my body (ie. could this cause spread)?  This whole process has been so stressful for me.  I'm at higher risk of breast cancer since my sister passed away from this at a very young age.  I appreciate your input,  especially any medical based input.
Thank you.

[BhumikaMD]

Hi,

Glad to be of some help to you. You shuld not worry. Take things slowly and each day as it comes. This will help you to think clearly and also make thoughtful decisions about your treatment and management plan.

Well an ultrasound is less accurate than a MRI, but it is fairly trustable.

Lets just hope for the best.

Your being nervous about the surgery is normal, just talk everything out with your surgeon and anesthesiologist. You could ask him/her about anti anxiety medications for a day before the surgery.

Do keep us updated.
Hope this helps.
Good luck.

[jen109]

Thank you all for the excellent advice.  I'll go ahead with my gynecological procedure (and pray the endometrioma is benign), then get a second surgical opinion about my breast biopsy.  Thanks for your support.  My sister was only 17 when she had breast cancer, so this is a scarey time for me.  I'm 31 now.  My biopsy said the result was consistent with a benign papilloma.  I also have multiple cysts and fibrocystic areas.  
I know this is a breast cancer forum, but do you think endometriomas can be diagnosed fairly well from the ultrasound (distinguished from something more serious).  I'm nervous about this surgery too.  
I pray that this will all be behind me soon.
Thanks for the advice and support.

[BhumikaMD]

Hi,

You need to discuss your situation with your doctor in detail and then decide what you feel most comfortable with.

It is true that a FNAC could miss the site of the lesion - and therefore the report come out as benign; but it is also true that an FNAC combined with a clinical examination and mammogram are considered adequate for the diagnosis of breast cancer.

You should not worry about the cancer cells spreading after a surgery to your lower abdomen.

It would help to know your age, the BIRADS classification your breast lesion was put into and also when are scheduled for the surgery for endometrioma.

I would suggest that you go ahead with the endometrioma surgery first, get a re evaluation of your breast lesion a few weeks later - both clinically and radiologically and then decide - in discussion with your doctor the further plan of mangement.

That ways - you would have gone through the ordeal of one surgery and handled one problem effectively and would be in a clearer frame of mind to decide about the breast lesion and further plan of management. And also, because the FNAC says the lesion is benign, it would not harm to cause a few weeks of delay.

Do let us know about your progress.
Hope this helps.
Good luck.

[often]

On the other side of the coin, I am a firm believer in surgical excision.  It is not unknown for FNB to miss the area completely. Nor is it impossible for mammograms to be wrong.  

I had lumpectomy, followed by re-excision for clear margins.  My breast surgeon made the incision for the margins right over my lumpectomy incision.  Had I not had radiation (which over time shrinks and destroys the tissue) I would have been left with a fine scar that was/is barely noticeable. I had a 2.1cm tumor removed, then the margins.  Without the rads, there would have been no noticeable "dent" or disfigurement from the surgery. Of course, location will have some impact on disfigurement.   I had a fantastic team of docs and my surgeon is very experienced.  I did not find the surgery brutal.    You do not state your age, but you do state your sister passed away at a young age.  As for your concerns with a different surgery spreading possible existing cancer, talk to the doc regarding this.  

Ultimately the decision is yours.  Which doctor do you trust the most.  What does your "gut" tell you?  Me, I would want to be positive.

[Tricia3]

If you've had diagnostic mammogram, ultrasound guided fine needle aspiration and everything is benign, you've done everything possible to rule out breast cancer. Unless you feel distinct hard firm or atypical (compared to regular feel of breast lumps) lumps you are fine. Surgery is brutal, especially in breast tissues and the scarring results in permanent disfiguration for life.