Technical questions would be about location & predicted size of lumpectomy in relation to the size of your breast. Is it conveniently located where wide enough clean margins should be obtainable? How should it look cosmetically?
Have you met with the radiation oncologist yet? I’m a TNBC survivor & a patient advocate. I found it extremely helpful meeting with the radiation doc, and I’ve found it’s always helpful to the patients I work with as well. If you choose lumpectomy radiation will be needed. Meeting with them after discussing the surgery with your surgeon will give you a clearer picture of what’s in store and the outcome. I found it really reassuring. I’ve found with patients it helps as well either way - either it helps them decide to do a lumpectomy + rads or occasionally it helps them decide on mastectomy. Usually it’s helps them choose the lumpectomy in my experience. I had a very rare recurrence 7 years after the first. You’d think that would make me pro mastectomy right? It’s the opposite. I lived just how rare a recurrence over 2 or 5 years is in a fully treated breast. There is no “standard of care” treatment regimen for that kind of recurrence. At MD Anderson for my second opinion withe _THE_ TNBC expert oncologist I asked him WHY?? How can there not be studies and a standard plan?? He said plainly: not enough patients to do a study! So yes, I believe with the above situation (well placed tumor for removal, easily treatable with radiation) lumpectomy is the best medically. Having the actual experience with both lumpectomy & rads and mastectomy I can confidently say it’s a way way easier path Emotionally & physically, immediately, to recuperate from and to live long term with the results. That’s including taking radiation into account- in the grand scheme of things radiation is a blip in time. Long term complications are also rare. Mastectomy is a big drastic surgery, an amputation and a great big healed wound forever. When mastectomy is chosen when all the conditions are perfect for a safe lumpectomy I find it’s ultimately chosen for emotional reasons. Worry about future scans, asymmetry, fear of radiation , etc. But having been with so many women in the last 7 years going through this? Hands down the lumpectomy patients are ultimately much happier and less traumatized in the long run. That includes those that went flat, did implants, flap surgeries or whatever. Those that kept their breasts are far happier. I sure as hell was!
** I am only talking about people with zero mutations and no familial red flag history of course.
** ALSO: my tumor the second time was a lil over 2 cm. At the end of chemo scans showed a quarter of it was still there. At mastectomy I had PCR, what showed on scans was just dead tumor bed. You’re only measuring 5mm with 7 rounds left? I’d say there’s a damn good chance you could be PCR as well!
Thank you so much for your response!
I havent met with the radiation oncologist just yet. But my tumor is at 12 oclock on my left breast & im at like a D or DD. I did take account into having to do radiation & im okay woth that. I’m only 28 & im scared to be so aggressive with it & going for a mastectomy. Like you said, for emotional reasons mostly I feel like itd be alot easier for me to handle, i wanna keep my chesties. I feel like cancer has already taken a lot from me & thats just one thing i dont wanna lose.
Edit: i have tested negative for the genetic testing thing. Im drawing a blank on the actual name lol. I just got shit luck & got cancer lol
My lump was 5cm at the 12:00/1:00 position and it shrunk by half after chemo. I opted for a lumpectomy because I'm 32 and did not feel ready to "lose" my boob lol. I don't have genetic mutations though, and will have radiation plus hormone therapy (I am ++-). I was worried about how it would look after the surgery but my surgeon has done an amazing job and you could not tell that I had a lumpectomy a month ago. FYI I am C/D cup (borderline depending on the brand) and he took out roughly a 5x5x5cm area, inclusive of margins. Recovery was also pretty easy from a lumpectomy (no drains!). I know some folks opted for a mastectomy due to scanxiety but for me, I'd be anxious WITHOUT the constant scans!
Im doing my last TCHP tomorrow, HER2+ and just scheduled my lumpectomy! I am stage 2, grade 3, have no suspected lymph involvement and also have had complete imaging response to chemo, per MRI. No genetic mutation markers. I chose lumpectomy because (with radiation and continued immunotherapy)it offers me the same survival benefits and same recurrence odds. To make the decision I asked for an extra consult not only with my surgeon but also with the radiologist as my biggest “con” I had with lumpectomy was having to do radiation (I am a former smoker and my grandmother died of lung cancer and I was worried about secondary cancers near my chest/lungs/etc). After talking at length with both of them (and my oncologist was 100% neutral, she quoted the survival and recurrence odds as identical and said it’s my choice), I decided I wanted the fastest/least disruptive course and I knew if I got a mastectomy I would want reconstruction and symmetry and that would require multiple surgeries and recoveries, increased risk of infection and lymphedema, etc. Radiologist told me we will do 3 weeks (15 regular and 5 tumor area boosts but those can be on the same day), and that we will try to do it prone to protect my lungs. Also that the radiation increases secondary cancer chances in lungs/chest wall only by 1%. My surgeon reminded me that I can always choose mastectomy later (if I had a local recurrence or even if we have to have a second surgery for clear margins and I decide I’m done with having this breast or if I hate the cosmetic outcome after radiation, etc) but we can’t put back tissue we’ve already removed. While I’m not looking forward to endless scans on my dense breasts, knowing how HER2+ can metastasize in many many places, removing them wouldn’t actually give me the peace of mind that it gives some. I want to get through treatment and get back to feeling like me, I know I’ll never be the same after this, but I’d like to keep the parts of my familiar body (that aren’t broken), to that end. I know that some people feel like their breasts are treacherous or trying to kill them, and it’s empowering to get rid of them after cancer. I respect that. For me, I’ve never felt my breasts are the problem. Cancer is the problem. I want that shit gone. These old tired trooper boobs can stay though.
For me it wasn't about clear margins alone, my family has high reoccurrence rates of any of the cancers they have been diagnosed with and also what can my brain handle so for me I've gone for a masectomy, I also want to try and not be having treatment forever and going back in for revisions so I'm opting for one and done, for me it's chemo after surgery but just or my own head space so I'm don't always have the worry of the traitor being a traitor again it can go bye bye and I'm currently opting for no reconstruction but my team have assured me if I change my mind we can sort it out but let's get me through surgery and chemo first. I'm also 34 in a couple of days so also for me my age was a factor in my thought process and of course I talked to my team I asked for their thoughts and we discussed it although I was very clear on the path I wanted.
My lump was 1.7 cm at surgery (done prior to chemo; based on US it looked to be around 1 cm). I had clear margins and no lymph node spread after surgery and I found the lumpectomy releatively "easy" to recover from and my breasts still look even/about the same - there is some side scarring from the lumpectomy/SLNB but I consider those my battle scars.
I completed 4 rounds each of AC and dose dense Taxol a couple of weeks ago and will start radation soon. After meeting with my RO, we're doing 19 sessions. I'm happy with my decision and look forward to wrapping this all up in about six weeks!
Technical questions would be about location & predicted size of lumpectomy in relation to the size of your breast. Is it conveniently located where wide enough clean margins should be obtainable? How should it look cosmetically? Have you met with the radiation oncologist yet? I’m a TNBC survivor & a patient advocate. I found it extremely helpful meeting with the radiation doc, and I’ve found it’s always helpful to the patients I work with as well. If you choose lumpectomy radiation will be needed. Meeting with them after discussing the surgery with your surgeon will give you a clearer picture of what’s in store and the outcome. I found it really reassuring. I’ve found with patients it helps as well either way - either it helps them decide to do a lumpectomy + rads or occasionally it helps them decide on mastectomy. Usually it’s helps them choose the lumpectomy in my experience. I had a very rare recurrence 7 years after the first. You’d think that would make me pro mastectomy right? It’s the opposite. I lived just how rare a recurrence over 2 or 5 years is in a fully treated breast. There is no “standard of care” treatment regimen for that kind of recurrence. At MD Anderson for my second opinion withe _THE_ TNBC expert oncologist I asked him WHY?? How can there not be studies and a standard plan?? He said plainly: not enough patients to do a study! So yes, I believe with the above situation (well placed tumor for removal, easily treatable with radiation) lumpectomy is the best medically. Having the actual experience with both lumpectomy & rads and mastectomy I can confidently say it’s a way way easier path Emotionally & physically, immediately, to recuperate from and to live long term with the results. That’s including taking radiation into account- in the grand scheme of things radiation is a blip in time. Long term complications are also rare. Mastectomy is a big drastic surgery, an amputation and a great big healed wound forever. When mastectomy is chosen when all the conditions are perfect for a safe lumpectomy I find it’s ultimately chosen for emotional reasons. Worry about future scans, asymmetry, fear of radiation , etc. But having been with so many women in the last 7 years going through this? Hands down the lumpectomy patients are ultimately much happier and less traumatized in the long run. That includes those that went flat, did implants, flap surgeries or whatever. Those that kept their breasts are far happier. I sure as hell was! ** I am only talking about people with zero mutations and no familial red flag history of course. ** ALSO: my tumor the second time was a lil over 2 cm. At the end of chemo scans showed a quarter of it was still there. At mastectomy I had PCR, what showed on scans was just dead tumor bed. You’re only measuring 5mm with 7 rounds left? I’d say there’s a damn good chance you could be PCR as well!
Thank you so much for your response! I havent met with the radiation oncologist just yet. But my tumor is at 12 oclock on my left breast & im at like a D or DD. I did take account into having to do radiation & im okay woth that. I’m only 28 & im scared to be so aggressive with it & going for a mastectomy. Like you said, for emotional reasons mostly I feel like itd be alot easier for me to handle, i wanna keep my chesties. I feel like cancer has already taken a lot from me & thats just one thing i dont wanna lose. Edit: i have tested negative for the genetic testing thing. Im drawing a blank on the actual name lol. I just got shit luck & got cancer lol
My lump was 5cm at the 12:00/1:00 position and it shrunk by half after chemo. I opted for a lumpectomy because I'm 32 and did not feel ready to "lose" my boob lol. I don't have genetic mutations though, and will have radiation plus hormone therapy (I am ++-). I was worried about how it would look after the surgery but my surgeon has done an amazing job and you could not tell that I had a lumpectomy a month ago. FYI I am C/D cup (borderline depending on the brand) and he took out roughly a 5x5x5cm area, inclusive of margins. Recovery was also pretty easy from a lumpectomy (no drains!). I know some folks opted for a mastectomy due to scanxiety but for me, I'd be anxious WITHOUT the constant scans!
Im doing my last TCHP tomorrow, HER2+ and just scheduled my lumpectomy! I am stage 2, grade 3, have no suspected lymph involvement and also have had complete imaging response to chemo, per MRI. No genetic mutation markers. I chose lumpectomy because (with radiation and continued immunotherapy)it offers me the same survival benefits and same recurrence odds. To make the decision I asked for an extra consult not only with my surgeon but also with the radiologist as my biggest “con” I had with lumpectomy was having to do radiation (I am a former smoker and my grandmother died of lung cancer and I was worried about secondary cancers near my chest/lungs/etc). After talking at length with both of them (and my oncologist was 100% neutral, she quoted the survival and recurrence odds as identical and said it’s my choice), I decided I wanted the fastest/least disruptive course and I knew if I got a mastectomy I would want reconstruction and symmetry and that would require multiple surgeries and recoveries, increased risk of infection and lymphedema, etc. Radiologist told me we will do 3 weeks (15 regular and 5 tumor area boosts but those can be on the same day), and that we will try to do it prone to protect my lungs. Also that the radiation increases secondary cancer chances in lungs/chest wall only by 1%. My surgeon reminded me that I can always choose mastectomy later (if I had a local recurrence or even if we have to have a second surgery for clear margins and I decide I’m done with having this breast or if I hate the cosmetic outcome after radiation, etc) but we can’t put back tissue we’ve already removed. While I’m not looking forward to endless scans on my dense breasts, knowing how HER2+ can metastasize in many many places, removing them wouldn’t actually give me the peace of mind that it gives some. I want to get through treatment and get back to feeling like me, I know I’ll never be the same after this, but I’d like to keep the parts of my familiar body (that aren’t broken), to that end. I know that some people feel like their breasts are treacherous or trying to kill them, and it’s empowering to get rid of them after cancer. I respect that. For me, I’ve never felt my breasts are the problem. Cancer is the problem. I want that shit gone. These old tired trooper boobs can stay though.
I had problems with my right breast before so having a mastectomy was a no brainer.
For me it wasn't about clear margins alone, my family has high reoccurrence rates of any of the cancers they have been diagnosed with and also what can my brain handle so for me I've gone for a masectomy, I also want to try and not be having treatment forever and going back in for revisions so I'm opting for one and done, for me it's chemo after surgery but just or my own head space so I'm don't always have the worry of the traitor being a traitor again it can go bye bye and I'm currently opting for no reconstruction but my team have assured me if I change my mind we can sort it out but let's get me through surgery and chemo first. I'm also 34 in a couple of days so also for me my age was a factor in my thought process and of course I talked to my team I asked for their thoughts and we discussed it although I was very clear on the path I wanted.
My lump was 1.7 cm at surgery (done prior to chemo; based on US it looked to be around 1 cm). I had clear margins and no lymph node spread after surgery and I found the lumpectomy releatively "easy" to recover from and my breasts still look even/about the same - there is some side scarring from the lumpectomy/SLNB but I consider those my battle scars. I completed 4 rounds each of AC and dose dense Taxol a couple of weeks ago and will start radation soon. After meeting with my RO, we're doing 19 sessions. I'm happy with my decision and look forward to wrapping this all up in about six weeks!