Milestones.
It feels remarkable that today, January 1st, 2020, the start of a fresh, new year (and according to some, a fresh decade), marks exactly six months since the diagnosis and marks me being on the other side of my last infusion. In a move that seems fitting, my plastic surgeon appointment was scheduled for New Year's Eve, so I could go into my new year with a settled plan.
I will be having a unilateral mastectomy on January 28th. Prior to my appointment with my surgical oncologist, this option felt farthest from my mind. I had expected to either have a lumpectomy with radiation, or a double mastectomy (with hopefully NO radiation). The problem was that neither of these options felt like the right one. While there is certainly an inclination to get all breast-related tissue off my body once and for all, I was having a not-insignificant amount of anxiety that a double mastectomy meant no more scans unless I had symptoms. Ever.
Some people choose a double mastectomy for this reason. They call it "scan-xiety" and hate the idea of holding their breaths every six months, waiting on scan results. I am the complete opposite. I had no recognizable symptoms at diagnosis, so what would I have to drive me back to the doctor? I found some solace in the fact that under the muscle implants would mean that a lump would be more obvious (because a mass would likely show in the muscle wall, which would now be at the surface). But I really just WANT scans to identify anything suspicious as early as possible. I would have scans with a lumpectomy, but a lumpectomy was not an option for me and my deflated post-breastfeeding, post-chemo breasts. By the time they carved out where both masses were, and the margins that have to be tested, there would be nothing left. "Not a good cosmetic result," my surgical oncologist said. Lumpectomy also came with automatic radiation, as mentioned above.
As it turns out, and as recommended by my surgical oncologist, a unilateral mastectomy gets me everything I need: removal of hopefully all of the offending breast tissue, cosmetic adjustments on the non-cancer side for symmetry, and, because I would still have breast tissue left on the non-cancer side, REGULAR scans. I will have a mammogram on the non-cancer side once per year, and an MRI of the entire chest once per year, meaning one scan or the other every 6 months.
The appointment with the plastic surgeon solidified this plan, and expanded. At surgery, all tissue/ducts will be removed from the cancer side, and the plastic surgeon will place a "tissue expander" - which looks and works like a water balloon - in the breast. We will do my surgery OVER the muscle, which yields an easier recovery and less animation (implants flattening out with muscle contraction, for example). However, over the muscle means that the implant goes right under the skin. Since skin is not that thick, and could lead to complications with delayed healing, I will have "ADM" - acellular dermal matrix, or biological mesh...or donor skin that is stripped of cells and tissue, leaving a mesh that gives me an extra layer of protection. Eep. There are pros and cons to both over and under muscle, but I feel good about the plan.
During surgery, the surgical oncologist will remove some of the sentinal - or in close proximity to the masses - lymph nodes and do a dye reactor test on them to see if they light up to suggest cancer. If so, they will be sent off for dissection and pathology. We do not anticipate them to be positive, because the MRIs and biopsies showed no infected lymph nodes, but surgery is the only way to confirm. While I'm on the table, the plastic surgeon will also test my blood flow. If it looks good, I will get about 180ccs of air to get me started. If it is poor, I will get less air, to allow for improvement before putting any stress on my skin. He will do a lift on the non-cancer breast at the time of surgery. A couple of weeks after surgery, I will see the plastic surgeon again for incremental injection of saline, to get the expander to the preferred size. If pathology confirms that my margins (the space surrounding where the masses were) are completely cancer free and I had no infected lymph nodes, my cancer treatment would be over except for antibody therapy (i.e. no radiation), and I can have "exchange surgery" once the expander is at preferred size - perhaps as early as two months after surgery. Exchange surgery involves re-opening the surgical site, removing the expander, and replacing with implants. This is why exchange is not done until cancer treatment is over: radiation can lead to rippling of the implant. At the time of exchange, I will have reconstruction (implant) on the non-cancer side if needed, for symmetry. Because we are going over the muscle, I will likely need an additional procedure involving fat grafting to fill in spaces so it looks smooth. I may also need an additional procedure on the non-cancer side once things have settled, if they are still not symmetrical.
This is a lot, particularly while juggling my herceptin infusions every three weeks until August. On more than one occasion, someone has commented that "at least I get new breasts" out of this deal, or "at least I get some 'free' liposuction." But the idea of three surgical procedures or more in a year is daunting.
Nonetheless, I feel encouraged. Having a plan and loose time frame puts my mind at ease and puts the end in sight.
Here is to 2020 being "the end." I have my heart set on Resilience as my theme of the year. And Health. I'm focused on what's next, and how I will care for this body that has gotten me through thus far.
And here is to Milestones. Six months since diagnosis. Scans every six months going forward. Turning 40 in 2020. Celebrating my 10th wedding anniversary in 2020. Being cancer free in 2020.
Happy New Year, all!
I will be having a unilateral mastectomy on January 28th. Prior to my appointment with my surgical oncologist, this option felt farthest from my mind. I had expected to either have a lumpectomy with radiation, or a double mastectomy (with hopefully NO radiation). The problem was that neither of these options felt like the right one. While there is certainly an inclination to get all breast-related tissue off my body once and for all, I was having a not-insignificant amount of anxiety that a double mastectomy meant no more scans unless I had symptoms. Ever.
Some people choose a double mastectomy for this reason. They call it "scan-xiety" and hate the idea of holding their breaths every six months, waiting on scan results. I am the complete opposite. I had no recognizable symptoms at diagnosis, so what would I have to drive me back to the doctor? I found some solace in the fact that under the muscle implants would mean that a lump would be more obvious (because a mass would likely show in the muscle wall, which would now be at the surface). But I really just WANT scans to identify anything suspicious as early as possible. I would have scans with a lumpectomy, but a lumpectomy was not an option for me and my deflated post-breastfeeding, post-chemo breasts. By the time they carved out where both masses were, and the margins that have to be tested, there would be nothing left. "Not a good cosmetic result," my surgical oncologist said. Lumpectomy also came with automatic radiation, as mentioned above.
As it turns out, and as recommended by my surgical oncologist, a unilateral mastectomy gets me everything I need: removal of hopefully all of the offending breast tissue, cosmetic adjustments on the non-cancer side for symmetry, and, because I would still have breast tissue left on the non-cancer side, REGULAR scans. I will have a mammogram on the non-cancer side once per year, and an MRI of the entire chest once per year, meaning one scan or the other every 6 months.
The appointment with the plastic surgeon solidified this plan, and expanded. At surgery, all tissue/ducts will be removed from the cancer side, and the plastic surgeon will place a "tissue expander" - which looks and works like a water balloon - in the breast. We will do my surgery OVER the muscle, which yields an easier recovery and less animation (implants flattening out with muscle contraction, for example). However, over the muscle means that the implant goes right under the skin. Since skin is not that thick, and could lead to complications with delayed healing, I will have "ADM" - acellular dermal matrix, or biological mesh...or donor skin that is stripped of cells and tissue, leaving a mesh that gives me an extra layer of protection. Eep. There are pros and cons to both over and under muscle, but I feel good about the plan.
During surgery, the surgical oncologist will remove some of the sentinal - or in close proximity to the masses - lymph nodes and do a dye reactor test on them to see if they light up to suggest cancer. If so, they will be sent off for dissection and pathology. We do not anticipate them to be positive, because the MRIs and biopsies showed no infected lymph nodes, but surgery is the only way to confirm. While I'm on the table, the plastic surgeon will also test my blood flow. If it looks good, I will get about 180ccs of air to get me started. If it is poor, I will get less air, to allow for improvement before putting any stress on my skin. He will do a lift on the non-cancer breast at the time of surgery. A couple of weeks after surgery, I will see the plastic surgeon again for incremental injection of saline, to get the expander to the preferred size. If pathology confirms that my margins (the space surrounding where the masses were) are completely cancer free and I had no infected lymph nodes, my cancer treatment would be over except for antibody therapy (i.e. no radiation), and I can have "exchange surgery" once the expander is at preferred size - perhaps as early as two months after surgery. Exchange surgery involves re-opening the surgical site, removing the expander, and replacing with implants. This is why exchange is not done until cancer treatment is over: radiation can lead to rippling of the implant. At the time of exchange, I will have reconstruction (implant) on the non-cancer side if needed, for symmetry. Because we are going over the muscle, I will likely need an additional procedure involving fat grafting to fill in spaces so it looks smooth. I may also need an additional procedure on the non-cancer side once things have settled, if they are still not symmetrical.
This is a lot, particularly while juggling my herceptin infusions every three weeks until August. On more than one occasion, someone has commented that "at least I get new breasts" out of this deal, or "at least I get some 'free' liposuction." But the idea of three surgical procedures or more in a year is daunting.
Nonetheless, I feel encouraged. Having a plan and loose time frame puts my mind at ease and puts the end in sight.
Here is to 2020 being "the end." I have my heart set on Resilience as my theme of the year. And Health. I'm focused on what's next, and how I will care for this body that has gotten me through thus far.
And here is to Milestones. Six months since diagnosis. Scans every six months going forward. Turning 40 in 2020. Celebrating my 10th wedding anniversary in 2020. Being cancer free in 2020.
Happy New Year, all!
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