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I have to decide lumpectomy or mastectomy and am loss

Posts: 4
Joined: Feb 2013

Started at a 5 cm tumor left breast.  16 weeks chemo and it is 2.5cm but MRI cannot tell if spots around the original footprint are scar tissue or cancer cells.  Doc says I can try a lumpectomy and if the pathology comes back positive would then have to have a mastectomy. I have to have radiation either way, and a lumpectomy on the other breast.  Or just have the mastectomy and reconstruction with expanders etc.  Says no answer is right and won't tell me what she would do; just says safer with the mastectomy.

I am loss and after horrible chemo for 16 weeks thought it would get easier.  I have to tell her Tuesday so she can schedule the surgery.  BTW this is one of the top ten surgeons in the country and a stellar comprehensive cancer center.  Anyone else ever been in this situation?

thank you all in advance,

Nellie age 51 

carkris's picture
Posts: 4554
Joined: Aug 2009

it depends on so many factors. So hard to make decisions when you are worn out. Please trust that things will sort out for you. I guess I would do what is the safest. I am bilateral without reconstruction. I also had rads on my chest. I dont love having a mastectomy but its not major in my life either. How do you feel about it? Is it awful to think of losina a breast? would a second opinion help you? Hugs

Noel's picture
Posts: 3100
Joined: Apr 2009

I am also wondering if you might want to get a 2nd opinion.  We have to make so many decisions and sometimes it might feel like we are being rushed.  I didn't have a mastectomy, I had a lumpectomy, as my doctors suggested for me.  I've never regretted my decision and that is important for each of us, to not regret our choices, if we have a choice.

Best of luck, Noel

Posts: 653
Joined: Oct 2012

We are all different in our perspective on things.  My situation is a lot like the other lady who left you a message.

I made my decision for a bi-lateral because I really did not want to have to do this again.  Just do it, I told myself.

Years ago, when I had a mass of tumors that meant either a myanmectomy (like a lumpectmoy) or hysterectomy, I chose a hysterectomy.  I did that because the DR had said that once they actually got in the area and saw what was there, they might have to do a hysterectomy regardless.  Even though I was just 31 at the time, I opted for the hysterectomy.  It seemed easier than waking up and finding the DRs had to do more.  I was able to start preparing myself ahead of time for the loss.  As it was, when they got in there to see what there was, they would have had to do a hysterectomy anyhow. 

I had surgery last February, chemo, and then rads.  Now I am on tamoxifen.  Things right now are looking good for me, although I am still not at 100% -- although I am not too terrible far off.

I hope that you will be able to come to a decision quickly and feel it is the right one.  An older lady friend of mine -- her daughter and I were best friends, until she succumbed to cancer two years ago -- said to me not to second-guess myself when making decisions about what to do as I have dealt with cancer.  We do the best we can with the information/knowledge we have.

Posts: 66
Joined: Jan 2013

Hi, Nellie,

My situation was different.  First they did a lumpectomy, but were not able to get everything.  So, the choice was a re-excision or a mastectomy.

I went with bilateral mastectomy with reconstruction.  In my case, it has helped me to avoid radiation.  I am very comfortable with my decision.

I'm 35 years old, and I knew I wanted reconstruction.  I lost about a third of my breast in my lumpectomy, and I was lopsided.  I currently have expanders in, and they're not the most comfortable things in the world, but it's livable for the moment.  Hoping for my exchange surgery for my implants in April/May.

I know breast preservation is big for some folks.  And, I would love to have my breasts back.  Things just feel differently.  But, I am happy with how things look cosmetically -- I don't feel self-conscious.  And, if I had known just how dramatically different I would have looked post-lumpectomy, I would have just gone for the mastectomy to begin with.  Although it may have been a blessing that I did not -- they needed to remove pectoral muscle to get clean margins, and we may not have known that without the lumpectomy.

Perhaps the best answer for you is to ask yourself what you are hoping for from the surgery (other than the whole cancer removal thing -- let's agree that is priority number one).  Are you looking for the least amount of surgery with the lowest risk of needing to go under the knife again?  Are you concerned with how you'll look cosmetically?  Are you interested in breast preservation?  Are you concerned about recurrence long-term?  How is the rest of your health -- and is one surgical choice better than the other with your health profile (i.e., will one give you a shorter or less extreme recovery time)?

Hope you come to the choice that works for you.  I'll be thinking of you.


Double Whammy's picture
Double Whammy
Posts: 2802
Joined: Jun 2010

When I first met with the surgeon, he started talking about mastectomy.   I don't know why.  I had to stop him and ask about lumpectomy.  I honestly don't know why he thought I'd be having a mastectomy - my tumor was tiny and grade 2 on biopsy.  I had standard "old lady ER+ breast cancer".

 I had a lumpectomy and my cosmetic result is really good, but that isn't always the case and it's something I think they fail to mention and something that should be considered as part of the decision making process if one has that option.  Of course, aleviating the cancer should be the first and foremost consideration.  "Lucky" for me, my breast with cancer was significantly larger than the other breast and we planned oncoplasty as part of my surgery.  Had it been in the other breast, the results may not have been so nice.  And - it was only by happenstance that I had oncoplasty in the first place.   I didn't even know it existed.  I was being flippant and made a remark to the surgeon about that breast being larger anyway and he suggested oncoplasty.   He basically did a mini breast reduction at the time of lumpectomy.  

For me, this was the right decision, but only you can make that decision for yourself.  Clear margins are very very important and having additional surgery is well, an additional surgery.  Scarey and not without risk.  It turned out that the margins around my tumor were not clear, but because of the planned oncoplasty, the chunk that was removed took care of that at the same surgery.  I don't know how it would have played out had we not planned oncoplasty.

Perhaps you should seek a second opinion to help you weigh the pros and cons of masectomy vs. lumpectomy given your circumstances. I just want you to be aware that neither surgery is without cosmetic ramifications and a lot depends on the size and symmetry of your breasts.  Maybe someone can chime in here who have had lumpectomy with less than good results.   In spite of what I consider my excellent results, I have a canyon in my breast where the tissue was removed and it's sort of flat bottomed.  My tumor was on the underside of my breast so this is really not at all noticeable, but I do notice it. 

Good luck on your surgery.  Let us know how everything goes and what you decide to do.


Posts: 242
Joined: Apr 2010


     BTW that was my grandmother's name. You have to do what is right for you. The only decision I had was if it was a bi-lateral or not. I have at times

regretted losing both breasts but then It doesn't bother me now. My surgeon said, it would probably occur in the other breast hence my decision. I had surgery

with expanders put in at the same time. Noone can tell you what to do, you have to decide. There is no right answer except the one you make. I hope this helps.



Megan M's picture
Megan M
Posts: 3001
Joined: Dec 2009

Just wishing you the best in whatever surgery you should choose!

Hugs, Megan


camul's picture
Posts: 2541
Joined: Dec 2010

I chose a bi-lateral, but at the time insurance said no reason so it was a single of the right breast.  My breast surgeon did a lumpectomy and while I was out the pathologist said she did not get it all so she woke me up, and asked if I wanted her to take more or do a mastectomy?  I asked her for her opinion, and she said a mastectomy.  So one week later I had it done.  I was 44 and never regretted my decision. 

Only you can make this decision.  I just wanted to have it gone!  I wish you the best.


Pink Rose
Posts: 493
Joined: Nov 2012

My onco and plastic surgeon recommended a lumpectomy with rads for me which is equal to having a mastectomy inre to survival terms.  I am very glad that I was able to save my breast.  You need to do what is best for you, after having all of the information you need.

Good luck!

MsGebby's picture
Posts: 659
Joined: Oct 2011

It's hard enough dealing with cancer to start with ...  having to make a decision about having a lumpectomy or mastectomy should come with some kind of instruction manual.  

My tumor was 3cm without node involvement.  I wasn't offered the "either or" method, just a lumpectomy.  I lost about a third of my breast.  It's not so bad actually since I am just a B cup.  I had to have a re excision to get clean margins so that might be the reason for so much tissue being lost.   My nipple is not "front and center".  It's sort of pointing to the right a bit.  In your situation, I have to agree with the ladies that this decision needs to be carefully considered.  If a second opinion will help you in making this choice, then please do that.  Ask your oncologist if you can have 1-2 weeks to decide.  I would think that would be OK.

Good luck to you.  I will say a prayer that you find your way to the right decision for you.



Posts: 2
Joined: Feb 2013

So sorry you're having to make this decision. I don't think any of those of us who have made it found it terribly easy - it's a very big decision to have to make and for once the doctors will only (at least in my case) advise - ultimately it's up to each of us to choose what's best for us. 

For me it was a choice that had to be made in light of several other severe health conditions I have which would have pretty much prohibited me from having chemo or radiation. I didn't need chemo (thankfully) as the cancer hadn't spread - but if I had it would have been life-threatening as I have a genetic immunodeficiency. Also I have Lupus - so this pretty well ruled out radiation (which they would have done after lumpectomy) - add to that the fact that there was too much cancer to get 'clear margins' with lumpectomy - and my decision was, while not easy, at least narrowed down - and I chose bilateral mastectomy (the cancer was only in one breast - but I did NOT want to go through it again being in such fragile health condition already - so I opted to get it all over with in one go & I do NOT regret it for a second).


So - i'm not sure if that helps or not but for me it boiled down to 1. what was healthiest for me (both physically AND emotionally) and 2. what was going to get the cancer out of me and leave me with a shot at recovering without major surgical or treatment complications.


Again - very sorry you're having to go through this - but it sounds like you're in good hands. I wish you all the best. Please let us know how it goes - i'll be pulling for you! I just had my bilateral mastectomy 3 weeks ago tomorrow and i'm doing really well. I wish you all the best.



New Flower
Posts: 4299
Joined: Aug 2009

Mastectomy saved my life even we did not know that my tumor was huge 6.5. If your doctor said mastectomy is safer for the future please consider her opinion each case is uunique patients with large tumors are better off with mastectomies

good luck


salls41's picture
Posts: 340
Joined: Apr 2012

Thats what my decision was all about. It didn't even come to a trying to make a decision for me. I am 53, I have beautiful grand kids I want to dance at the weddings of. When I found out I had cancer (mine is triple negative and aggressive) I asked for a bilat. Mastectomy. I did my chemo, had my surgery. I went with immediate recon. but mine was unfortuantely halted and expanders removed when I developed a infection. So I am now 53, flat chest, big bellied memaw with chia pet hair and I am cancer free. Everyone is different on what is important to them. I hope you find peace with whatever decision you make. For me, I just didn't want to ever have to say what if.. if my cancer comes back. I threw everything I could at the beast and I pray I did enough.

I also think your surgeon is telling what she would do when she says Mastectomy is safest.

Good Luck and God Bless.


Gabe N Abby Mom's picture
Gabe N Abby Mom
Posts: 2415
Joined: Sep 2010

Because my dx was triple neg inflammatory BC, it was an automatic modified radical mastectomy for me.  My decision was just the left cancer side? or both?  I did chemo first, and spent the entire 4 months of chemo debating in my head, and discussing options with my hubby.  And I went back and forth...I eventually chose a bilateral.  It was more important for me to be even.  Frankly, my breasts sagged.  I didn't want one pointing at my toes and a concave hole on the other side.  I have not had any reconstruction.  Considering my situation, both now and then, I am content with my decision.

I know this doesn't help you make your decision.  But whatever you decide, you will get support here.  And there will be people here who can answer questions.  Best wishes.





missrenee's picture
Posts: 2137
Joined: Apr 2010

Everyone is different, but here's my story.  A little over 3 years ago I was diagnosed with invasive ductal ca with 10 positive nodes (making it stage 3).  My surgeon recommended a lumpectomy with axillary node dissection, to be followed by aggressive TAC chemo and then rads.  I followed his advice because he is one of our top guys here, so why wouldn't I.  I was definitely happy with my choice. 


HOWEVER, about a year ago, it was discovered that I had bone mets (T-12, L-1) so I had more rads in those bones.  Then, in October of last year, following a bilateral breast MRI, it was discovered that the cancer had recurred in the same breast, different location.  I had an immediate mastectomy but could not have reconstruction because of all the rads and very, very tight skin over that area.


In retrospect, if my surgeon and I had a crystal ball, we would have done the mastectomy right away.  But, we hoped for the best and it didn't happen that way.  I do not regret any decisions I've made.  Regret is just a waste of time and no one can predict the future.


Do what you feel is right for you right now.  If things change, you can change course if you have to.  Good luck and come back here--we'll support you with whatever you choose to do.

Hugs, Renee

susie09's picture
Posts: 2933
Joined: Jul 2009

Trust your judgement and your gut feeling.  I feel lucky that I could have a lumpectomy and radiation treatments, no chemo.  Your doctors will help to guide you to what is best for you.  We are all different.

Wishing you good luck!

Treecy1106's picture
Posts: 159
Joined: Apr 2011

Hi Nellie....

Decisions during the time of a cancer diagnosis is truly a test of your strength. God knows we who are on this site all can relate.

I also was Triple Negative BC. IDC stage 2A. I had 4 tumors in my left breast 2 were over 2 cm and cancerous the other 2 were smaller and benign. Nothing showed on a mammo or ultrasound I felt something and a fine needle biopsy was done.

The first question I have for you is...were you told you have dense breasts???? I do and thats why nothing ever showed on any test for over 12 years having had mammos and ultrasounds every 6 months. 

AFter the fine needle biopsy an MRI with dye was the way they saw something in my breast.

Now the decision....my Dr. said...you can have a double lumpectomy but most of your breast tissue will be gone. So of course that bothered me. So I agreed to a mastectomy on the left breast but then I said....no test showed anything until the tumors were over 2 cms and from an MRI...I cant live with worrying everyday about this. SO I opted for a bilateral. 

After my surgery the pathology report came back that I had the beginning of ILC in the right breast as well. No MRI, Mammo or ultrasound found that cancer either!

In retrospect..... I am thrilled I made my decision. 

I was also told b my Dr. that you will hear more women complain and say they are sorry they didnt have the mastectomy then women who have had mastectomy's  instead of lumpectomy's.

God Bless You with the strength of mind and body to do the right thing!!! Remember ITS ALL ABOUT YOU!!!!




Posts: 4
Joined: Feb 2013

Thank you to all for your input.  There is no time for a 2nd and I have total faith in this doctor and facility and kind of wish she didn't give me this choice to make.  Also afraid of the reconstruction and the time, difficulty of it.... I just don't feel I have enough information to make a good decision.  Long term survival is first and foremost so I am 80% decided.  If you could think of any other questions I should ask her before making up my mind that would be helpful.  I'll be meeting with the plastice surgeon as well but after the decision is made. thank you all for sharing your wisdom and your strength.  Nellie

Pink Rose
Posts: 493
Joined: Nov 2012

Why isn't there time to get a 2nd opinion if you don't mind my asking?  A lumpectomy with rads is equal to a mastectomy for survival and in recurrence.  If you don't have to have a mastectomy, discuss this with your breast surgeon thouroughly. 

I think some women have a mastectomy not knowing those facts and with a mastectomy, there is no way at all that all of your breast tissue is removed, so, you always have some.  I don't think some know that either. 

Keep us updated on what you choose and how you are doing.



Posts: 4
Joined: Feb 2013

They need to book the surgery and get what remains out.   A lump and radiation is not equal to a masc....it is not that straight forward.  The original tumor shrunk like 'astoroids' or a 'sponge' and the many spots around it could be scar tissue or cancer cells.  No way of knowing until after surgery with the pathology report. If cancer cells I have to go back in for the mascetomy.   Either way I have to have radiation.   It is a pure gamble and the best chance of long term survival is the masc. according to the surgeon but she still gave me the other option.  This is UCSF (I hope I'm allowed to say) and she is one of the top 10 surgeons in the country.  I do trust their advise and kind of wish they did not give me a choice. 

As it is now I am 99% sure I am choosing the masc. as my goal is long term survival.  I am just afraid of what is next.  thank you.

New Flower
Posts: 4299
Joined: Aug 2009

I almost figure out your llocation under California law doctor is obligated to discuss all options, including lumpectomy and explain that a breast conserving option is available, even if she believes in other better route for the patients 

good luck 

Angie2U's picture
Posts: 2992
Joined: Sep 2009

Hi Nellie!  It sounds like you have your mind made up for a mastectomy and that is great if that is what you feel is best for you. 

None of us know until after our surgery, lumpectomy, if the breast surgeon got clear margins.  Most breast surgeons will take more tissue than necessary usually to be sure they have clear margins.

Also, some women have NO choice but to have a mastectomy.  They are NOT candidates for a lumpectomy and you could be one of those women.  However, if a pink sister has a lumpectomy and follows it up with rads, it is equal to a mastectomy, the same survival rate and recurrence rate.  Your doctors should know this information. 

I, ofcourse, wish you the best of luck with your mastectomy and pray for a lifetime of health and happiness!



Pink Rose
Posts: 493
Joined: Nov 2012

We were afraid and still are at times.  But, you're never alone and you have us to turn to if you need strength. 

Good luck with your surgery.



New Hope's picture
New Hope
Posts: 18
Joined: Jan 2013

I had to make that decition back in November I had told the Dr.I was thinking of a lumpectomy and that what we had made plans for .I really thought I was ok with that but something deep inside of me just could not go for the lumpectomy the day of the surgery I call the hospital and told them I wanted the surgery but wanted the mactectomy instead.I am doing good It has took some time getting use to my left breast being gone .But I am glad to be cancer free.That was what I really wanted more then anything.I'm sure you will make the right choice for you.


Posts: 4
Joined: Feb 2013

Thank you Hope.   My gut feeling is telling me the same. May I ask if you did the reconstruction surgery too and how it was for you?  N

McMarty's picture
Posts: 212
Joined: Nov 2012

I had the mastectomy and reconstruction (DIEP Flap) all done in the same surgery.  You might ask if that is an option for you?

DebbyM's picture
Posts: 3293
Joined: Oct 2009

Have you made your decision yet Nellie?  Whatever you should choose, lumpectomy or mastectomy with or without reconstruction is always your choice.

Wishing you the best always,


New Hope's picture
New Hope
Posts: 18
Joined: Jan 2013

No I went to see a Plactic surgent but because of my dibetis he did'nt think it would turn out good. And I had had to many surgery scars to do the flap type replacement.And not knowing tell surgery what treatment would be needed to many question unanswered to make a good decision .I am glad with the one I did make I feel good and I still may get a second opintion on the reconstrution. Right now I am so thankful that I did not have cancer in my ovaries like they first though I may have.3wk after my mactectomy I had my ovaries removed because of cyst on them that until surgery they could not till for sure was not cancerous also. Hoping for the best for you


DianeBC's picture
Posts: 3886
Joined: Jun 2009

Wishing you good luck Nellie on whatever surgery you decide on.

Hugs, Diane

Posts: 4376
Joined: Jun 2009

Nellie, have you made your final decision as to your surgery?  We are here to support you and help you in anyway. 

We will get the pink bus out to ride along with you when you do have your surgery.  Just let us know the date when you can.


Hugs, Jan

Posts: 176
Joined: Oct 2010

I'm late to this thread and you have probably already made this decision, but I would go with what is safest. I also had a 5 cm tumor, chemo first to shrink and it went to 2.5, but my surgeon said she felt I was equally safe with the lumpectomy and radiation. So I chose the lumpectomy. But she gave me the choice and said she was pretty confident that I would have clean margins. I did and so far all is well. However, if my doctor had said masectomy would be safer, that's what I would have done. Best to you. Hope all is well and you are at peace with your decision.

Pink Rose
Posts: 493
Joined: Nov 2012

I hope that whatever surgery you decided on, if you've had it already, was successful and that you are doing well.


Will keep watching for your update.


Hugs, Rose

smbrand158's picture
Posts: 19
Joined: Oct 2011

One thing that I really appreciated about my surgeon and oncologist is that they were very open with their advices as to trying to save my breast with a lumpectomy or having single or bilateral mastectomy. They gave me really good information about my chances of having the cancer return to my other breast after chemo, radiation and 5 years of medication and they reminded me that I was a young, vibrant 53 year old and that by leaving my "good" breast I would still have sensation on one side. Now, after wearing a prostisis for a year, I feel that I wish that I would have taken both breasts so that I would be symetrical, but that will be taken care of soon with reconstruction.

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