breast lump excision wrong site excised

[cbcowgirl]

I am new to the board and need direction.  I had surgery on my right breast 2 weeks ago, for an intraductal papilloma in one duct with suspicious shadow below it, with bloody nipple discharge.  I also had a small palpable lump on the right inner breast near ribs, that was not seen on mammogram or ultrasound.  They were to excise and biopsy it at the same time as the ductal excision. After surgery my surgeon told me he was 99% sure they were benign.  Pathology came back, showing no mass or papilloma, and of normal breast tissue.  I did a self exam of my right breast and the lump is still there.  He missed it. I saw the surgeon again, he said he was 99% sure it was a cyst, so he tried to aspirate it, and no fluid was removed.  It is solid. Now wants to redo everything, all tests and surgery again because he thinks none of the tissue needed to be removed, was removed.  In pre-op, the nurse had my husband and I mark a red X on the breast to be operated on.  I asked if the lump should be circled, she said no, the surgeon knew where it was.  The surgeon told me he made his incision at the red X, and found a mass so he took it.  There was no mass there or indicated on pathology.  He screwed up, and now I have to start all over again from scratch, with 2 nasty scars on my right breast, and still no correct diagnosis.  I am furious and don't know where to turn. I am scared that this is a cancer, and he didnot get it.  Any suggestions?  Thanks for listening.  I am scared it is DCIS.  Any thoughts?

[CCF-RN,MSN-rf]

Dear cbcowgirl:  In general, if a lump can be palpated (felt), the surgeon uses this method to remove or biopsy the lump.  In some cases, an ultrasound may show a lump that a mammogram did not, although it is usually best at differentiating solid versus cystic structures.  Even in the best cases, the tissue in question can sometimes be missed.  If you are not comfortable with your surgeon, consider a second opinion with another surgeon, preferably someone who specializes in breast surgery.  

[healthcareguerilla]

Well, first you'll find another surgeon, if only because you no longer have faith in him.  Since the mammogram showed nothing, perhaps you can avoid having that duplicated, and your new medical 'team' that you'll find will order other imaging.

I am not certain why you especially note fear that it is DCIS, as that is an in-situ condition, although of late, and for no reason I can discern, I've read stories of more vigorous treatment for DCIS, but I suspect that depends upon where a woman is seen.

I am sorry you are going through this.  I had a FNA that was positive for malignant cells; then a core biopsy which missed the spot and came back negative. (No one needs this kind of confusion). This led to my having to convince anyone to do anything about the malignant cells.  I had an excisional biopsy which found DCIS and LCIS.  No further treatment was ordered.

Do what you need to do to get the right evaluation of the lump, with people who will confer with each other -- radiologist, pathologist, breast surgeon etc.  And you're doing some research on all this yourself, I trust, at this and other reliable medical sites.  Glad you are angry. It beats the fear.  Keep your head about you.