• How successful is a lumpectomy in getting clean margins? A 30% need for a second surgery seems high! Why?

    Asked by Loafer on Thursday, September 20, 2012

    How successful is a lumpectomy in getting clean margins? A 30% need for a second surgery seems high! Why?

    13 Answers from the Community

    13 answers
    • nancyjac's Avatar
      nancyjac

      Well technically it is always successful because tissue and tumors will be removed until their are clean margins. For women who are concerned about breast saving surgery, the surgeon will be conservative in the amount of tissue removed and only take more if more is needed to achieve clean margins. 30% actually seems low to me.

      about 5 years ago
    • Ydnar2xer's Avatar
      Ydnar2xer

      I had a lumpectomy in 2003 and had to go back for a second one a week later. It was explained that they hadn't achieved clean margins the first time. I think it must be tough to get it perfect each time because the doc doesn't want to take more than necessary, but still rid the woman of all the cancer...and that's not easy! I believe my doc got it all after 2x.
      This second breast cancer of mine now, although in the same right breast, had different markers, so I believe it's a different cancer, not a recurrence.

      about 5 years ago
    • ladybug's Avatar
      ladybug

      I don't know about statistics, but I actually had 3 lumpectomies!. Last fall, after the second lumpectomy without clear margins, I was advised to have a mastectomy for which I started planning . While researching breast reconstruction options, I contacted the Mayo Clinic in Rochester for information about the DIEP procedure. During the phone conversation, a very perceptive nurse asked if I'd be interested in consulting with the Breast Clinic there for a 2nd opinion. I jumped at the chance. After reviewing my records, and doing additional mammograms and ultrasounds, they concluded that I was a candidate for a 3rd lumpectomy which was scheduled for November. That one did have clean margins! Radiation followed for six weeks and now I'm on tamoxifen for 5 years. I feel very confident that it was a good choice for me to make. I will continue with semi-annual check-ups without any worries

      about 5 years ago
    • ruthieq's Avatar
      ruthieq

      Well you know its not like the tumor is neon green or lights up and says here I am. The Surgeon is going to try and be conservative regarding tissue so you won't have too much of a change. That being said, there is the chance that they don't "get it all'. Then you have to go back.If you have more than one are you might consider partial mastectomy (they have prosthetics for that too.) so as to have clear margins and less conservative need. If you don't have nodal involvement, this might be the way to go. Its not all or nothing here, choices are :Lumpectomy, partial mastectomy, mastectomy, or modified radical mastectomy. ALWAYS YOUR choice.

      about 5 years ago
    • teddyfuzz's Avatar
      teddyfuzz

      I also had to go back in for a second surgery after I was told that the margins weren't clean. It seems like the doctors excise what they think will be clean margins but you probably can't tell until you get things under a microscope. That's my thought anyway. When they told me I would have to go in for a second surgery I told them to just take the whole dang boob - and the other one too! Dang boobs.

      about 5 years ago
    • Laurie's Avatar
      Laurie

      1. If you don't have an actual lump, there is nothing to see in surgery (hence the needle location pre-op). Xrays pick up pinpoint calcium dots, which show up white on the black xray. Your tissue is whitish yellow, so it doesn't show against it. So, they go to the area and just get a big chunk out.
      2. Some tumors have microscopic "tentacles", if you want to see it that way. They may have the full primary tumor, but a "tentacle" maybe got cut off or is only 1-2 mm from the edge.
      3. You may have more than 1 tumor and not know it! Every bit of tissue is gone thru and checked. Not all tumors show up on mammograms.

      30% seems high to me. I wouldn't sweat it. The standard is lumpectomy unless there is a specific reason not to (like won't have enough breast left or already know nodes positive or something). Trust me, you DON"T want the mastectomy, which was the old standard, no matter how small the tumor.

      about 5 years ago
    • Loafer's Avatar
      Loafer

      Just got results back from lumpectomy - with all clear margins- a shout out to my talented surgeon! She removed two cancer sites and one non-cancerous site, as well as sentinel lymph nodes. I was assuming with a 30% fail rate, my odds would double with two sites.... I wanted less invasive surgery and breast preservation - and was nervous about the decision. Ready to move forward with the next phase of treatment!

      about 5 years ago
    • cindycrosby2's Avatar
      cindycrosby2

      Herceptin (5x) damaged my left ventricle function so i am not able to continue with that treatment.Has anyone else experienced this? Did 6 rounds of chemo/33 radiation for stage 1 breast cancer HER2+.

      about 5 years ago
    • SueRae1's Avatar
      SueRae1

      Cancer treatment including lumpectomies are an art as well as hard science. Every case and individual is unique, based on many factors the surgeon determines how large the margins will be. Only the pathology report can tell the whole story. cancer is a tricky devil, it hides well from the naked eye. I was fortunate to only need 1 lumpectomy, but my margins were very large because I was being treated for kidney cancer (which I still am) and needed to be off treatment before and after the surgery. Do not be discouraged.

      about 5 years ago
    • nancyjac's Avatar
      nancyjac

      I have to respectfully disagree with you Laurie. I have had breast cancer twice. The first was a small tumor 20 years ago, I had a lumpectomy and a lymphectomy. Earlier this year I had a mastectomy and no lymphectomy for inflammatory breast cancer with no clear tumor. Of course, in hindsight, I wish I had had the mastectomy 20 years ago, but obviously mastectomy was not the old standard treatment for small tumors. If anything, it is more the standard today because of solid scientific evidence of the advantages of a mastectomy over a lumpectomy.

      about 5 years ago
    • Laurie's Avatar
      Laurie

      Hi Nancyjac. It depends on the cancer. I believe IBC is an automatic mastectomy (post chemo) due to it's severe nature. Most other lumps do NOT need one, it depends on type and grade. Some people prefer mastectomy for DCIS because it could show up in other areas along the tract of the milk duct from seeding cells breaking off from the mass. Some people prefer mastectomy for high grade tumors, because they are more likely to recur/ met.
      Back in the old days (like up to at least 70's) full mastectomies were done pretty much all the time. They also did more radicals (with removal of chest muscle and all axillary lymph nodes). By early 2000's, studies showed (for DCIS) that lumpectomy with radiation worked equally well. That is also when SNL started to be more popular, since studies showed that it was about equally accurate as axillary dissection and had a lot less post-op problems. In 2010, studies were done that showed if the SNL was positive, that there were equal outcomes with chemo compared to axillary dissection with chemo, but I don't know if all the surgeons believe it. I know of no study that shows a predilection for IBC later if you've had another type of breast cancer earlier. IBC isn't that common (doctors can easily miss it, thinking its mastitis).
      I should have made it more clear when I said "you don't want a mastectomy" that I meant because of pain, post-op issues, length of recovery time, etc, compared to lumpectomy.

      about 5 years ago
    • nancyjac's Avatar
      nancyjac

      I think you missed my point, which was that cancers, those that have them, and the treatments for them are varied. It might be comforting for some if it were all nice and black and white, but it isn't.

      It may well be that there is no correlation between IBC and previous breast cancers, but again, that is not the point. If I had had a mastectomy with my previous cancer I would not have had breast, and therefore I would not have had IBC.

      I agree that SNL was a popular TV show, but I assume you are referring to SLN (sentinel lymph node).

      I've had both a lumpectomy and a mastectomy. The pain, post op issues, recovery time, etc. were about the same for both surgeries.

      And no, IBC is not an automatic mastectomy, nor it is always post chemo.

      about 5 years ago
    • Laurie's Avatar
      Laurie

      Ha Ha Nancyjac! Good answer on the SNL! Oops.
      Really?? Your mastectomy was no worse than your lumpectomy? Wow. Good for you. If I hadn't done bilat mastectomy, you'd never drag me back for the other one. I've had multiple lumpectomies and was always back at work next day (in fact, the second one, I got picked up from hospital by friend to take me out to her farm to go hiking in the woods!) without any pain meds. I was not really prepared for just how much my mastectomy would hurt. On the other hand, I figured getting "spayed" would be worse, since mastectomy is basically skin and fat and ovariohystectomy is abdominal, and yet that was pretty much nothing (I did have robotic laparoscopic, not open abdomen, tho). Go figure.

      almost 5 years ago

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