surgery options for high grade DCIS with microinvasion

I was recently diagnosed with high grade DCIS with microinvasion.  The initial diagnosis was for straightforward DCIS, but a second biopsy after an MRI showed it to be more advanced, with a smaller secondary lesion. The whole area that needs to be removed is approx 4cms.  I'm told I can have a wide local excision with radiotherapy, but that I may loose the nipple because the main lesion is very close to it.  Because of the size of the affected area, in relation to my "relatively modest breast size" my surgeon believes I may go on to need a mastectomy because it will be hard to get clear margins.  For peace of mind, and to avoid a second surgery I'm considering going straight for the mastectomy and in fact would possibly prefer a bi-lateral.  I feel I'd rather be balanced even if that means removing both breasts and have the option not to have to match my remaining breast by always wearing a form.  I'm in the second half of my 50's with children and grandchildren and am sure that I do not want to have re-construction.   Has anyone else had a similar diagnosis?  Were you pleased with the outcome of your surgery?  I'd appreciate any advice to help me decide how to progress.

  • www.cancerresearchuk.org/.../ductal-carcinoma-in-situ-dcis

    Hello cococo.  I am attaching some information about DCIS which may be useful but also because it will bring your post back onto the front screen.  Some days posts come in fast and furious!  I haven't anything to contribute to the dicusion (sorry!) but hope that someone who has will pick it up.  Cheers.  Annie

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    Hi Cococo,

    I am sorry to hear that you find yourself in this predicament. I lost both parents, many family and close friends to cancer myself. I then got a diagnosis of breast cancer 8 years ago and had a lumpectomy, followed by Tamoxifen. A year later I had a second bout in the same breast. At the time I had a lump in my other breast too, but this turned out to be benign. I had a double mastectomy and then took Letrozole for 6 years. I found it easier to deal with the mastectomies than the lumpectomy. After I had the lumpectomy I was taking all sorts of detours to avoid speed humps, potholes, etc, as I was very sore driving over these devices. I didn’t have that bother with the mastectomies.

    I have a rare form of breast cancer called mucinous or coloid cancer. This only affects 1% of the cancer population and is not very aggressive, so my surgeon was surprised when it returned so quickly. I felt much better when I had my double mastectomy, as I felt that it had all been removed, whereas there was a query after my lumpectomy as to whether or not a clear margin had been attained. I was advised to have radiotherapy after my lumpectomy, but didn’t due to some procedural errors. After I had my mastectomies I was told that I did not need radiotherapy or chemo.

    Due to previous surgery, I was unable to have reconstruction, but I have managed well with a selection of prostheses for different applications. I still go to the gym, attend exercise classes, go swimming and can even wear fairly low cut tops. There are times when it can be a mild inconvenience, but on the whole I manage well. I had my lumpectomy when I was 61 and my mastectomies at 62. If I were to be given the choice again I’d opt to go straight for the mastectomies, but it’s easy to say that with the benefit of hindsight.

    This is a decision that only you can make as you have to be happy with it for the rest of your days. I hope that you reach the right decision for you.

    Please keep in touch and let us know how you get on. We are always here for you whenever you want to talk.

    Kind regards,

    Jolamine xx

  • Hi Coco

    I had almost the exact same diagnosis as you  in March 

    2011 at the age of 49.

    I wasn't offered radiotherapy as my DCIS was multi focal. I went for a skin sparing mastectomy and immediate LD flap reconstruction. A year later I had an uplift and reduction on my remaining breast and a new nipple fashioned and tattooed on my new breast. I am delighted to tell you that nearly 10 years on I am in excellent health and Most of the  time forget I ever had this diagnosis  or surgical procedure. It wasn't all plain sailing - I had seromas - but generally my recovery was pretty good. I'm quite happy with the appearance of my reconstructed breast and the surgery hasn't prevented  me living a fulll life. I swim three times a week and do aqua fit which helps keep my arm and chest area supple. 

    I hope everything is going well for you. While I was mightily relieved not to be diagnosed with invasive breast cancer I did worry about the micro invasive element of my DCIS for a while. My oncologist assured me at the time that other therapies - chemo etc- weren't necessary and I accepted her advice.

     

    take care