Breast Surgery Discussion - Take 2

LI - where is my mind...

(Boob Alert - 
Illustrations of Lumpectomy & Mastectomy are included in this blog - you were warned)

Neoadjuvant chemotherapy was now complete and it was time to discuss my MRI results and figure out the best course of action... lumpectomy or mastectomy. My original plan was the lumpectomy, but I was not going to rule any particular procedure out. So, I headed in bright and early to talk with the breast surgeon.

Time to make up my mind... maybe?!

Shortly after meeting with the nurse, the doctor entered the room and we discussed the recent MRI. The mass had shrunk. Yeah! They considered it enough that the chemotherapy had worked. Yeah! All good news. The mass had gone from 3+ cm to 2+ cm. I really wanted the mass to be gone, a ghost tumor, but they seemed pleased by the results! And just like they hoped when I did chemo first, I was a great candidate for a lumpectomy - which also was called breast conservation surgery and partial mastectomy... a lot of names for removing a chunk of your boob!!!

Before they would talk details he wanted to make sure it looked or felt like the MRI, or as best as he could tell. So they left and I got to change into one of those light peach, sexy, paper, hospital shirts that open in the front. They are beyond ugly, but they are disposable and practical so I get why they are used. Then I got to be examined. Another person gets the honor of messing with my boobs... currently, I have had a number of men and women getting that privilege!?!?!

Once I was re-dressed we discussed all the options - which still seemed a daunting choice. Of course, just like the Oncologist I was explained that both options (for me) were equally as good and had the same survival rate!!!

Minus the chemotherapy for me as I did that first...

  

I was still partial to the lumpectomy (aka. breast conservation surgery, partial mastectomy) primarily because it was less invasive and had the same survival rate. The surgery was an outpatient procedure and required less recovery time. 

Also, I would be able to get my pathology report back and have more information to go on. I could find out things like: Were my margins clear? How many, if any, lymph nodes were removed? Did I lose more of my breast than I realized? 

I did learn, one of the the benefits was that I could always opt to have a mastectomy at a later time... even long after the lumpectomy. You can take more boob off - you can't really put more natural boob back on... now fake boobs are another option!!!

Lumpectomy with Axillary lymph nodes removed...

However, I was not going to just choose that option without learning more about the mastectomy. After everything I have gone through (chemotherapy) there was that small part of me that still wondered if I was doing all that I can to live if I didn't choose the mastectomy. That thought mostly stemmed from all of the reaction I have gotten from people when I said I planned to have a mastectomy. 

It seemed that most people (not doctors) kept implying that without doing the mastectomy, the most aggressive surgery, that I was not really aggressively trying to live. It was not that it was worded that way, but it seemed that to most people that was the only practical option. Or that they were so focused that it was the only option that would prevent future breast cancer.

The mastectomy would require a 3 day hospital stay and around a month with dealing draining tubes. The surgery had multiple options for reconstruction (creating boob and nipples) and each provided different benefits and challenges. Because I wanted to know more about breast reconstruction, the nurse scheduled for me to meet with a Plastic Surgeon's nurse to discuss it in further detail later that day.

Mastectomy with Axillary lymph nodes removed...

The mastectomy would still leave breast tissue in the body. And that tissue can get cancer too. So, neither option was going to be a full-proof 100% way to prevent cancer again.

Both my Oncologist and Breast Surgeon told me statistically they were equally as successful (as long as I did radiation after a lumpectomy). Both doctors felt that both options were good for me and would not choose one over the other. I almost wish they had - it would have made a no brainer choice.

In my head...

I went ahead and scheduled the lumpectomy procedure for Thanksgiving week, but knew if I changed my mind that the surgery date would be postponed. I was going to meet with the Plastic Surgeon's office to learn more about the mastectomy before I would either opt to chop or rule it out. Heck, I might not like the way I look after a lumpectomy or be afraid of doing all this again at a later time, so I need to know the good, bad, & ugly!!!

Before I made any definite choice, I was having the Breast Surgeon's office find out a few important details:

1. Did the Oncologist feel that the chemotherapy was effective? Because if they felt chemotherapy was going to need be done again, then I wanted to do that before surgery. Keep that lump in to monitor the effectiveness of chemo! 
2. If they did feel my chemo was over could my port be removed? That would be a bonus!
3. Did both doctor's agree about my options? Was the lumpectomy really as successful in my case? I guess I wanted reassurance regarding my choice or at least the choice I hoped would work for me.

Both option are overwhelming. And there was no "right" or "good" choice. Basically, I just needed to make the "best" choice for me. Either way, I would have to make up my mind... well I needed to make up my mind soon!!!

“Crying is all right in its way while it lasts. But you have to stop sooner or later, 

and then you still have to decide what to do.” 

- C.S. Lewis, The Silver Chair

Episode Reference: Where is my mind, Pixie's song

(don't watch if you don't know or 

don't want to know the ending of Fight Club)