Close margins post mastectomy

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Hi there, sorry for the long post. I was diagnosed with DCIS high grade in March 2021. My Sentinel node biopsy was clear. I am 42yrs old. I had a therapeutic mammoplasty in April and was due to have radiotherapy however, the margins were not clear and I had a mastectomy with immediate reconstruction with ADM and silicone implant 4 weeks ago. I received my results two days ago showing close margins less than 1mm in one small area (close to my skin)all other borders had 2mm clear margins. I am very confused how to move forward. I’ve been told I can either take it the border is clear and keep watch for any changes.  Have radiotherapy but they don’t feel it is necessarily going to be helpful or my other option is to remove the implant and most of the skin leaving no ability to reconstruct thereafter as there would be no space for a further implant.

Has anyone else been in a similar situation?Are these the usual options? Does radiotherapy not help in this situation? Are chances of recurrence in this situation high? The surgeon has said he concentrated making sure the area that showed close margin was as clear as possible but obviously he cannot guarantee no cells remain. The MDT have not been able to come to a consensus on the best option for me and have left me to decide on how I would like to proceed.  Any input or similar experience would be greatly appreciated. Again sorry for the long post! 

  • Hi,

    I had a mastectomy and had a positive margin of 0.5cm and so was advised radiotherapy, so had 15 sessions. It is normal practice to only treat with radiotherapy following a mastectomy if their are positive margins. Hope this helps. 

  • Hi thank you for taking the time to reply I really appreciate it. That’s really helpful

  • Hi all 

    I had a lumpectomy 2019 and full node clearance. Then after chemo had a cavity shave for better margins then had rads to breast and underarm, full blast to everything, I know there could be lymphodema etc but I just needed everything thrown at it and would have asked for it if they hadn't done it, where I was treated it's standard practice. 

    Xxx

  • Hi Pusheen

    Thank you for your reply. I appreciate it.  I have spoken to my BCN today and she has booked another appointment with. my surgeon to chat through my options again. Hopefully I will understand what the best way forward is after that. x

  • Hi I have had a theraputic mammoplasty with reduction on other side but could not get clear margins because of dcis. I am now having a masectomy with immediate reconstruction. Could you please explain how you get a positive margin by having a masectomy pls. My lymph nodes are clear. Best wishes xx

  • I'm small breasted and the Surgeon said he had taken all the breast tissue during the mastectomy, it's the only reason I was given Radiotherapy following a mastectomy, in case any cancer cells were in the positive margin. NICE Guidelines which the Surgeons have to follow indicate this as the reason for RT after a mastectomy. 

  • Thank you  I have dcis which didn't show on my mammogram so my first surgery was theraputic mammoplasty, I am now having masectomy with immediate reconstruction. My lymph nodes were clear, do I need radiotherapy on my lymph nodes  Best wishes xxx

  • If the lymph nodes were clear, they wouldn't be offering radiotherapy, I didn't get it to the lymph area, despite 2 positive nodes.  All the best with your Surgery. 

  • Peterswake - Can I ask how you have gone about self funding your tablets you have switched to as mentioned in your profile. Just wondered how it works going private -  if more choices with things like that if you are paying/private type of thing. 

  • FormerMember
    FormerMember

    DCIS GRADE 3 found 2cm lymph nodes clear on initial ultra sound

    Lumpectomy booked and one small area didn't show clear margin  

    Second scrape booked and another 2cm found that hadn't shown on mamo

    Third aggressive scrape took place and another cm found

    Smx and sentinel node removed two weeks ago and results were, low risk, no further treatment required, no invasions. All clear. In total 6cm DCIS found