The Surgery Decision

From the beginning, I’ve known that I would have some kind of surgery after chemo. I was told that the lump was so large, approximately 5 cm, that I should have chemotherapy first. Otherwise, it would have been a straight shot to a mastectomy. I wanted as many options open to me as possible, so I started chemo.

My The cancer responded very well to the chemotherapy. The oncologist had put me on the highest dose possible due to my age and this being the second cancer I’d had. My The lump started shrinking after the first treatment. (I’ve been doing the erasing in my head. I’m not owning that shit. It was done without my cooperation.) The lump was virtually nonexistent after the fourth treatment. I was thrilled with the response. I thought for sure that I was going to be eligible for a lumpectomy. I did figure that I was going to lose my nipple no matter what because it had been involved, i.e. the nipple starting to invert was one of the signs of the cancer. The surgeon called me a few days before my appointment to let me know that my MRI came back clean. With all of that information, I was fairly confident walking into the surgeon’s office in what the surgery would be.

Should’ve known that it wouldn’t be simple. Nothing with this cancer has been.

haters gonna hate

I was completely thrown when, after she examined me, she asked, “So, what are you thinking?”

Inside: Uh, isn’t the reason you get paid the big bucks is because you went to school to know what to do? Do I look qualified to make these decisions? The fuck?

Outside: I said, “Lumpectomy?”

She just stared at me for a minute. Then she said, “I’m going to go check the MRI one more time.” My husband and I just looked at each other. Uh, okay? It didn’t sound like she had anything to say that was bad, but it just felt ominous.

When she came back, she sighed and said that her recommendation was that I get a mastectomy. The issue was that the lump was in the center of the breast. This meant that the images they got when this whole thing began were not great. So, even though they had an idea of what was what, the lump was not well defined in the midst of dense tissue. Essentially, they were kind of shooting blind when they did the biopsy. It was just as likely that they got the center of the mass as it was merely an edge. My surgeon said that if she did a lumpectomy she’d be afraid that she didn’t get all of it. Her exact words were, “I’d sleep better” and that was good enough for me. The surgery decision was a mastectomy.

Then she said, “I think I can save the nipple.” Whaaaat? She said that she’d test the tissue behind the nipple for cancer cells during surgery. If that came back clear, then I’d be able to keep it. It all depended on what that test showed.

To be honest, the thought of losing my nipple does bother me. I don’t want to be missing a part of me. I’ve researched my options. First, I looked up nipple reconstruction surgery.

running snow white

Nope Nope Nope Nope

With that out, my options are a 3D nipple tattoo, nipple prosthetics, some kind of tattoo, or nothing. I’m sure the asymmetry would drive my OCD tendency into freakout hyperdrive if I didn’t replace it. I’m really hoping that I get to keep it so then I don’t need to make any more decisions. My brain is so tired.

My surgeon also said that she would test some of my lymph nodes while I was in surgery. If those came back negative, I might not need any radiation. This was also very different than what I had been led to believe. I was told that I’d most likely need radiation. Woohoo! I’ll be very happy if I don’t need radiation. I’ve looked at pictures and heard stories. That does not seem to be a pleasant experience. I would like to remain ignorant of that process.

So although nearly everything I’ve thought as been thrown out, I’m pretty content with my decision.

What the surgery entails

A mastectomy is not as scary as it once was. There are many different types of mastectomy surgeries. The one that most commonly jumps to mind is a radical mastectomy. This is where the surgeon removes all of the breast—tissue, lymph nodes, and chest wall muscles. It is invasive and can leave ugly looking scars. This was the most commonly done surgery in the past because a) breasts were not considered important physically so who gave a shit about how it impacted the patient and b) they’re weren’t as good at diagnosing and treating breast cancer then. They have found that a modified radical mastectomy (where they remove the tissue and some to all of the nodes) is just as effective. That is the procedure I’ll have done. The interesting thing is that the plastic surgeon and my breast oncology surgeon will be in the operating room together. Once my oncology surgeon has performed the mastectomy, the plastic surgeon will step in for the reconstruction.

There is a small chance that I will be able to have an implant installed the same day as the mastectomy. The plastic surgeon gave it a five to eight percent chance. Which is weirdly exact, but I appreciate specificity. Mostly likely, I will have a tissue expander like this one put in.

expander cut

It is similar to a deflated basketball. Well, they’re smaller as I’m not going that direction in size. Anyway, they have a similar texture to a basketball. They are placed in between the chest wall and the pectoral muscles.

tissue-expander-illustration-300x260

They have a silicon port where they, at regular intervals, inject saline solution. They slowly expand to the size of the implant. Once that happens, the implants are placed.

implants

The implants nowadays are quite different than previous incarnations, especially the silicone implants. The new ones are made of a more cohesive gel. If the implant should rupture, the gel is designed to stay in a clump so that it doesn’t just float all over the body. On the other hand, saline will disperse harmlessly and be safely eliminated. I still have not made a decision on whether I’ll have saline or silicon implants yet. All I know is that I don’t want to end up like this:

w&g water bra leak

w&g water bra leak cover

There is a lot of information on the Internet about the evils & dangers of breast implants. However, little of it has any scientific basis. There are a few sites here, here, and here that take out hysteria and rely on facts. The certainly are dangers and drawbacks to breast implant surgery. Unfortunately for me, it really is an all or nothing deal. I’ve got thinking to do!

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