Are you really saying you want to choose between removing the cancer and
 reconstructing the breast?  Or do I misunderstand the question?  Is
the choice between mastectomy and a 3rd excision?  I presume it must be.

I think if two excisions fail to get clean margins it would be usual to
 go for a mastectomy next.  That's what my mum had for a stage I.
There are advantages to mastectomy, it is "cutting along the dotted
lines" so the healing, the scar and maybe the reconstruction, are
simpler and radiation can often be safely omitted.  The risk of
recurrence is less: long term outcomes are about the same, but
lumpectomies more often need further surgery to remove local
recurrences.  And you can wear a prosthesis instead of (or while you
consider) reconstruction.  Simultaneous ?-ectomy and reconstruction is
pretty heavy surgery with long recovery.

I believe that the preference for the more difficult surgeries, ie
lumpectomy or immediate reconstruction is partly due to a perfectly
natural denial of the loss of part of your body.  It is I know very
difficult to accept permanent changes to your body image, and very much
easier to see this as a wound which will heal and get back to "normal",
with just a scar.  It isn't and it won't.  Whatever you chose this is a
permanent change to your body and whatever you do to restore your
'public' image is cosmetic.  It leads to better clinical decisions,
mental health, and long term outcomes if you can manage to come to terms
with this difficult fact early on.

Tim Jackson

For me having  a mastectomy was not as physically challenging as I thought
it would be, I had a skin sparing mastectomy and Tram reconstruction. I was
up and about several days later and driving in 2 weeks. Are you planning
reconstruction?
http://www.breastcancer.org/tre_surg_skinsparing.html

What were the choices your team present to you?

Sorry you have to be here, but the people here are  tremendous in supporting
one another.

You really have a tough decision and I wouldn't presume to tell you what to
do.  I had a second resection and was not unhappy at surgeon for margins
still involved as I know he was trying to save as much of me as possible.
Do you know if the cancer was estrogen related?

One thought, if you go for 3rd and it is clear,  you might want to ask about
MammoSite radiation rather than the 30 treatments.  Dr. would have to decide
if you are a candidate for this considering size of tissue removed, etc.  I
was very pleased to be able to have had this.
PD

I had a mastctomy last year end of March with an expander put in
immedietly. The dr. said I wouldn't tlike the results of a lumpectomy as
I had a large lump in the center of a small breast. Also I had been told
of too many who had lumpectomies that later had to have mastectomies
anyway. The expander was gradually filled and in Oct. was replaced with
a saline filled form. The reconstruction is a poor substitute for a
breast but much better (to me) than nothing. This is a very personal
choice that only the woman can decide. Good luck.

O yes.  I didn't have to have radiation or chemo. I chose Arimidex after
readng about it compared to Tamoxifen(sp?) It sounded like Arimidex was
a better choice for me.

Hi, Myra,

I had bilateral mastectomies, radiation on one side.   The mastectomy
surgery itself is an easy one.  The various forms of reconstruction add
difficulty & recovery time.  For many, though, the loss of a breast is
unthinkable, so reconstruction is a requirement for them.

I am one (of quite few, perhaps?) who is not especially bothered by not
having breasts.  (Of course, I really mean I'd rather not have had the
breast cancer, but having had it, I'm satisfied with the mastectomies as
part of treatment!)

For me, the lowered odds of recurrence were an important factor, along
with the relative ease of detecting local recurrence as compared with
detection in a reconstructed breast.  I also didn't want to assume
additional medical risk (more difficult/risky surgery, possible
complications from implants or tissue necrosis).

Further, many reconstruction approaches reduce one's physical capability
at least temporarily, by surgical involvement of muscle tissue.  I'd
rather be strong than look good, if it comes down to that, and even if
the loss of strength can be mitigated by physical therapy.

Sometimes I wear prostheses (work, dress-up occasions), sometimes I
don't (most of my private life).  When I don't, not only do people not
stare, but they often don't notice.  (A number of times, I've been in
conversation with someone, mentioned I had breast cancer, and had them
register surprise . . . even as I was standing in front of them wearing
a t-shirt, completely flat (or even a little concave)!

For context -- since folks sometime say things like "but if you were
younger . . . or single?" -- I'm 49, 44 when I made the decision, and
single (widow).  I think my (late) spouse would've been fine with it,
too, considering the alternatives.

I know this is a very tough, and a very personal decision.  I don't mean
to criticize others who may choose differently from me -- one needs to
be guided by ones own values.

Good luck making the tough decision!

Ann T.
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