Surgery Choices: Why I Decided to Have a Lumpectomy

I chose to have a lumpectomy in fall 2019 after my DCIS diagnosis.  This decision-making process was a challenging one, and I wanted to share with you how I walked through it. There were five major reasons that I decided to choose a lumpectomy instead of a mastectomy.  

Note: I am not a doctor. I am not giving medical advice in this post. I would like only to share my patient experience with you so that you can understand how I came to my decision. Always consult your medical team for advice. See this page for more information.

Once I was diagnosed with DCIS, it seemed like I had so many choices to make. The most major decision was which surgery to have. Would I have a lumpectomy to remove the DCIS, or would I choose a mastectomy?   

There were five major reasons that I chose a lumpectomy over a mastectomy for this particular diagnosis. 

1. DCIS in One Location

My DCIS was located in one area of my right breast. It was found during my very first biopsy, and it was about 4 mm in size.  

I had many mammograms, ultrasounds, and an MRI, and the imaging didn’t reveal any other areas of DCIS in either of my breasts.  

The DCIS was low grade, small, and only in one location in my breast. This meant that my surgeon would be able to remove the cancer while preserving a nice cosmetic appearance in my breast. This was important to me, and something that I had many conversations with him about.

If my DCIS was in multiple locations in my breast, I would have made a different surgical choice.

2. No Genetic Factors

I was 41 at the time that my DCIS was discovered. Because of my relatively young age at diagnosis, my surgeon wanted me to consider genetic testing. This would help us better understand if I had a genetic mutation such as BRCA that would increase my risk of future cancers.

Between 5- 10% of cases of breast cancer are associated with a genetic mutation, so genetic testing isn’t standard in the United States when someone is diagnosed with breast cancer.  

I met with a genetic counselor, who had me fill out a family history of cancers and then was able to talk about the genetic testing options available to me. I was offered three levels of testing through my doctor’s office.  Your options may vary depending on where your genetic tests will be performed. Here are the three options I was offered: 

• Breast cancer risk test: Tested for the most common genetic mutations associated with Breast cancer.
• Expanded BRCA Test: Ran a profile of additional genes associated with breast cancer risk
• Full CancerNext : Included additional  genes would impact overall cancer risk

We ordered a rush on the testing for the breast cancer risk so that we could make sure to get the results before my surgery. 

I decided to run all three genetic tests at this time because I wanted to have as much information as possible in hand to help me understand my full genetic risk factors for cancer.

If I ended up being positive for the genetic mutations associated with increased breast cancer risk, I would plan on doing a mastectomy.

It was a great joy when my genetic counselor called me to tell me that I was negative for all of the genetic mutations associated with cancer risk.

I felt even more comfortable choosing a lumpectomy because I didn’t have any genetic risk factors which would increase my risk of invasive cancer.

3. No Lymph Node Involvement

One of the ways that breast cancer can spread outside of the breast is through the lymph nodes. If cancer has spread to the lymph nodes, then surgeons will remove the impacted lymph nodes as a part of the surgical treatment.

Initially, my surgeon was confident that there was no lymph node involvement in my case. My initial imaging only indicated a small area of DCIS on my right breast.

Then I had an MRI which led to three more areas of concern, all on my left side.

One of the areas of concern was a lymph node on my left side. This was the opposite breast of the DCIS diagnosis. The MRI and subsequent ultrasounds were inconclusive with regards to this lymph node. So, my surgeon ordered a biopsy of this lymph node to see if it was cancerous.

There are several lymph nodes in the breast, and not all of them can be tested at this time using a core needle biopsy. 

 Sometimes the lymph nodes need to be tested during surgery using a different procedure.

In my case, there was a lymph node under my armpit, called an axillary lymph node which could be tested for malignancy using an ultrasound-guided core needle technique. Here is a rather technical article if you’d like to read about it. 

My lymph node biopsy came back negative!

I was thrilled with this result because it was the final piece of medical information that I needed to make my surgical decision with confidence.

4. Quicker Recovery Time

As I discussed my treatment options with my surgeon, I asked him which surgery he would recommend. He told me that his treatment preference for me was a lumpectomy because of the small area of DCIS and the quick recovery. 

The surgical recovery from a lumpectomy, at least in my case was  about two weeks. After that time, I was cleared to do most of my normal activities.

If I had decided on a mastectomy plus reconstruction I would be looking at a much longer recovery time, one that would be months instead of weeks.

5. Keep the Girls (for now)

The final, and probably the most important reason, that I chose to do a lumpectomy was that it would allow me to keep my breasts.  

I wasn’t ready to say goodbye to my breasts yet. My diagnosis gave me the option to keep them. So, I did!

 I had some frank conversations with my surgeon about his confidence to get clean margins and also to preserve the cosmetic appearance as much as possible. We discussed his techniques at length, and I was confident that his goal was to remove the cancer with as little impact to my remaining breast tissue.

I’m about a year out of surgery, as of this writing. I have two small scars: one from the removal of a benign lump, and one from the cancer. I am really satisfied with the cosmetic appearance after the surgery.

We all have unique diagnosis and treatment options. Making a surgical decision is one of the biggest decisions we make in our breast cancer treatment. We must take the information we have and then move forward with a choice. Once we have done that, we can begin our journey towards recovery!

Do you have any words of encouragement for other people facing a surgical decision in their breast cancer journey?