<< I'm wondering if he is suspecting that the cancer has spread further?

It sounds as if he did not get clear margins the first time and that the cancer
may be multi-focal.  That doesn't mean, though, that it has spread beyond the
breast.  However, if more than one malignant lesion is in the breast it is
considered multi-focal.  
After surgery the recommended treatment protocol for what you described
generally includes both radiation and chemotherapy.  The type of surgery
recommended, though would vary based  on individualized factors.  Generally
speaking, most surgeons would report that there is no difference in terms of
statistics regarding overall survival between doing lumpectomy and mastectomy,
although there is a significant difference in terms of risk of local
recurrence.  The risk is less for those having mastectomy.  
I hope this covers the questions you had re. what is going on with your mum.  

oops sorry other post was accidentally sent before edited and finished.
It also sounds as if your mom is having lymph node testing done as well. There
are different ways of doing that.  One is called a sentinel lymph node biopsy
in which blue dye is injected into the area.  The dye generally would go to the
main lymph node(s) if there was any cancer involved.  If that has already been
determined and it felt necessary for more to be evaluated or removed that might
involve a separate incision and generally the first two levels of axillary
lymph nodes would be taken.
My best thoughts and prayers are with your mom.  Hope all goes well with
minimum discomfort and positive results.  Take care.  {{{Hugs}}}

I'm so sorry, Thomas, to hear that your mom has breast cancer!

There isn't really enough info in your note to be certain, but there are
some common scenarios that could explain the situation.

Often, after they remove a lump, they find that the edge of the
cancerous part is very close to the edge of the tissue they removed.
They like to get what they call "clear margins" -- an ample area of
tumor-free tissue removed all the way around the lump -- for safety's
sake.  I'm guessing maybe the "more breast tissue" part of your mom's
next surgery might be for this reason.

Also, it is pretty standard to remove lymph nodes (a.k.a. lymph glands)
under the arm on the side where the tumor was.  If they didn't remove
any during her first surgery, then it's not surprising they'd do that
now.  If they removed one or two during the first surgery (this is
called "sentinel node biopsy"), and they found malignant cells there,
that would also be a reason to go back & remove more lymph nodes.

Either way, removing lymph nodes *is* to see if the cancer has spread
further, but it's a normal part of the surgical process (done for almost
everyone).  In some cases, the surgery happens all at once, in other
cases it happens in stages.

So far, based on what you've told us, there is not reason for extreme
panic on your part.  Your mom's lump was quite large, but not huge.
(For example, I know women with a lump twice that large who's doing fine
six years after treatment.  I had one lump -- largest among a total of
five in one breast! -- that was about the same size as your mom's, and
I'm doing fine 3.5 years after treatment.)

Right now, for your mom, a lot of the prognosis will depend on the
status of the lymph nodes (do they contain cancers cells, and if yes,
how many of them do).  Breast cancer with positive lymph nodes is still
treatably successfully for many, but the more nodes are positive, the
more worrisome the situation.

They will probably do other tests on your mom, too.  Common ones are
blood tests, chest x-rays, bone scans, sometimes CT scans or MRIs.
These look for cancer that has spread elsewhere in the body, beyond the
breast & underarm lymph nodes.  That kind of spread would be very
serious.  It would also be relatively unusual at initial diagnosis, so
odds are good that all your mom's tests of this sort will come out OK.

Given the size of your mom's lump, my guess (and I'm not a medical
professional) would be that she may be facing chemotherapy and
radiation.  Again, don't panic!  These are no darn fun, and she'll need
your support and love, but these treatments are not as bad as many
people believe from what they hear in news reports and read in magazines.

Please keep us posted on how things are going with your mom, and ask any
questions you may have.  We'll try to help.  This is a good group, and
questions from family members & caregivers, as well as cancer
patients/survivors, are welcome.

Sending postive wishes your mom's way --

Ann T.
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