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Deciding between lumpectomy and mastectomy

Posts: 17
Joined: Jun 2017

I was diagnosed with grade 3 invasive ductal carcinoma, stage 3b with at least one lymph node involved. Due to the size of the tumor and the lymph node involvement, I am having chemotherapy before surgery. I've had 13 rounds and have 3 more to go. My oncologist says if the tumor is small enough after the last chemo, I may be able to have a lumpectomy instead of mastectomy. Either way, I will need radiation because of the lymph node involvement. My understanding is that history has proven that mastectomy does not give a better survival rate than lumpectomy with chemo and radiation. How do I make this decision? I've asked several women who have been through this and they've said it's very much a personal decision. They just felt "safer" going with a mastectomy. Is there a reason (other than personal feeling of security) to put myself through a double mastectomy with reconstruction when the doctors say a lumpectomy is just as effective? 

tufi000's picture
Posts: 755
Joined: Jun 2005

Get a second opinion. I went for doublemast. 2003

Teach76's picture
Posts: 351
Joined: Jul 2015

I was grade 3 PR+/ ER+ / Hers 2 - with no lymph node involvement.  Like you I had chemo first which thankfully shrunk my tumor.  Surgeon decided on a partial mastectomy ( about half).  Clear margins at surgery and I had 25 rounds of radiation after.

A second opinion is always welcome - I was glad that I had gone for that.  The initial thought was to treat hormonally for 6 months.  I was glad second surgeon was more aggressive and consulted with onco for an overall plan.




Posts: 527
Joined: Aug 2016

Hi, when I was first diagnosed, my first impulse was to have a double mastectomy because I thought it would improve my chances of survival and lessen my worries of recurrence. I got two opinions and both doctors agreed that a mastectomy was not warranted and would  not improve my chances at all.  in making these decisions, we can only go by the numbers that exist right now. I don’t know what your doctors are telling you. Turns out, there are regional differences in the USA and there are more mastectomies performed in certain parts of the country. In the northeast, the rates of mastectomies is low. My surgeon explained that the only time they perform mastectomy is when the tumor is inaccessible and cannot safely be removed or when the cancer is so widespread that it is the only option.  it is so hard to make a rational decision when we are terrified by the diagnosis, but try to look at the numbers and understand that there are often complications with mastectomies that require multiple surgeries and have lifelong side effects. I had a lumpectomy with radiation. It was a one day surgery, relatively simple recovery, and healed very quickly. Nobody would ever really be able to tell by looking at my breast. There are no scars. The radiation was pretty uneventful and healed very quickly. Good luck making your decision. 

Posts: 259
Joined: Mar 2017

Everyone is telling you the right thing...get a second opinion it you can!  Everyone's body and situation is sooo different and what may help for one person may not for another...

Prayers and Hugs to you and your Family!

and to everyone on this Network!!!Smile

continue to BEEpositive

WLButterfly's picture
Posts: 1
Joined: Oct 2017

Hello everyone. I was just diagnosed with invasive ductal carcinoma. The doctor siad it looks like it was caught early. It doesn't look like it has gotten into my lymph nodes. I have been needing a breast reduction and have decided to have the reduction at the time of my lumpectomy. This doctor seems to think this would be a good time since after radiation I may have issues healing. Have any of you gone this route. My tumor looks small. When they do the surgery they will test the tissue under my arm right before the lymph nodes to see if there are any cancer cells. I am also having an MRI before the surgery to make sure there isn't any cancer in other areas of my breast. I do have a nodule that showed up on the other side but they don't really think it is cancer. They just want to make sure. I feel like this is the right route for me. It's all really scary. Any imput would be appreciated. Thank you.




Posts: 527
Joined: Aug 2016

I think you need to wait to get pathology results before you know what is next. 

bkjljones's picture
Posts: 2
Joined: Nov 2019

I to have invasive ductal carcinoma. My lump was almost 4 cm. I am in the middle of six rounds of chemo and have to decide on a lumpectomy or a mastectomy. If I have just a lumpectomy then I have to go through five weeks of radiation. Radiation really does scare me. If I do a mastectomy even with one breast I don't have to do radiation.My surgical oncologist said that she can do a full mastectomy and leave me with maybe enough tissue for an a cup. I'm not really worried about having breast I'm just worried and concerned about making the right choice and if I need to have a full Mesec to me. But it is also a mind over matter type thing if they're not there then you can't get breast cancer but then there's always the chance of getting something else down the road, or not getting anything else. It's like spinning the roulette wheel.

Posts: 2
Joined: Jan 2020

I have the same kind of br east cancer and decided on a lumpectomy and have just finished radiation.  The only side effects I have are fatique and red tender skin which is supposed to improve with time.  Doctors want me to start hormone blockers next which also have side effects so I will have to decide.

Apaugh's picture
Posts: 856
Joined: Aug 2016

It is your personal choice.  Getting a lumpectomy or a full mastectomy will not change your outcome. If your cancer comes back, it will.  simple as that.   I had a double mastecctomy followed by chemo.  I dont regret that.  It was tough.  The SE are awful and life long.  I did not have radiation, but I heard from many it is tough too and it too can have SE.   

Get a 2nd opinion.  Dont rush into it.  Get a third even.  Then make your choice.  

Let us know how you do.



Posts: 2
Joined: Nov 2020

What kind of SE did you have from your chemo and double mastectomy, may I ask? I'm finishing up chemo and making this very decision right now. I'm likely going to have radiation either way, I'm told.

Thank you. :-)

Posts: 36
Joined: Jun 2019

I had triple negative stage 2a or b depending on who you are talking to. I had a lumpectomy, I had just two lymp node involved and I think a totoal of 11 removed. My doctors said that a mastecotomy was not nessasairy. I did have intence radiation because mine was very aggrecive and hard to treat. My radioalogst didn't leave anything to chance, he did the full treatment. I also had it in my left breast so they had to be sure the heart woundn't be involved. It wasn't. It really is a personal choice, I just couldn't see the advantage of the mastecotomy over the the lumpectomy. 

Posts: 5
Joined: Jun 2020

I also have triple negative stage 2A in my left breast. I'm told it's the size of breast and location of lump that might affect the breast after radiation. I was told a lumpectomy would make my breast smaller and radiation might shrink it further amd may misshapen it. My lump is small but in the "bad" location of 6:00. Can I ask where your location was and if you're happy with your outcome after radiation? I'm scared of a misshapen boob but also of a mastectomy.

Posts: 2
Joined: Nov 2020

Do you know why they took out so many lymph nodes if only two were involved? I ask because I had possibly two involved before chemo and now I'm looking at surgery in December. Having more than a couple of them out didn't occur to me. I'm also triple negative and have been told I'll likely get radiation no matter the surgery I decide on.

Posts: 3
Joined: Feb 2020

If you are going to have lymph nodes removed, having radiation increases your chance of developing Lymphedema.     I agree about getting a second, third, or even a fourth opinion! 

Missesmm's picture
Posts: 6
Joined: Oct 2020

For me personally, my decision was based on the results of my genetic testing.

I am negative for any of the 35 "cancer genes"...also the Dr. told me that on TCHP therapy, there is a 95% chance it will never return.

Therefore, I have decided on a lumpectomy.  Whatever you decide, I wish you the best.

Posts: 1
Joined: Oct 2020

Early October I was diagnosed with invasive DC E+ on right side grade 2 3cm and an MRI found on left small invasive DC/L E & P+ grade 2 .6 cm. They recommend lumpectomy with 4-6 weeks radiation & 5 years hormone blocker. My concern is if it is in both breasts, which is unusual, maybe my best route would be bilateral mast & pass on radiation. How many women have had a lumpectomies and then ended up going back in for a mast? Not sure how to make this decision. 


Posts: 55
Joined: May 2019

It's almost similar to my surgery.  I had a lumpectomy (only in one breast), and decided to have bilateral mastectomy months later.  I had 6 -8 weeks of radiation and now 5 year hormone blocker and no reconstruction.  I have known some people having surgery and opted out of radiation and hormone pill.  I decided the bilateral mastectomy months later because some have to go thru the same thing years later in the other breast (but not all people, only some).  I do understand you said both breast.  Some people like me just wanted to get it over with and not be cut again down the road.  Some people chose lumpectomy because they need to return back to work soon, while others chose bilateral mastectomy for no reoccurrence.  You make your own choice according to your situation.  I had my lumpectomy and return back to work in 3 weeks .  Months later I had my mastectomy and return back to work less than 3 months.  November 2020, it will be 2 years since my surgery.  I have ups and downs, but I am still here.  When I started taking those hormone blockers, I had serious side effects and still do sometimes, but I have learned to managed.  Think carefully and ask your doctor a lot of questions.Laughing

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