Surgery

Part 2: Meeting with the Breast Surgeon for Surgery Options

FlowFocusOn January 21st, I met with Dr. Ganaraj for the 2nd time to find out what my options are for surgery after chemo. I have been in chemo for over 3 months and the latest MRI from December has shown that the tumor in my breast went from 4.2 cm to microscopic in size and the cancer in my lymph nodes has shrunken from 3.8 cm to 1.2 cm. YEAH!!!

To mentally prepare for this meeting, I have allowed myself the time to discover the benefits of all surgery options: a lumpectomy (removal of the tumor in the breast), mastectomy (removal of one breast), bilateral mastectomy (removal of both breasts). Although I have been able to find perks (pun intended) for all options, I had my heart set on a simple lumpectomy.

In fact, here is exactly how I wanted it to go…

Surgeon swoops in with a huge smile on her face doing a happy dance and says…“Oh wow, we are all so blown away with your progress and the cancer is almost gone! I’m 100% confident it will be gone by the time you finish chemo. For surgery, we will only need to take just a little bit out to triple check the tissue is cancer-free. You won’t even notice a difference in your breast.” Then she would lay out the timeline for the rest of treatment so I can finally make other fun “life” plans this year.

Ok, so I see I was a bit attached to this specific outcome.

While working on my previous “Part 1” blog post, I began to re-live the thoughts & emotions from the 1st meeting and started to feel uneasy about the meeting this week. I was taking the past and projecting it into the future ~ that’s what the mind does. What if the news she shares is again shocking and not what I anticipated? What if I am, again, naïve about what I think is a surgical option for me? And the biggest thought, “I won’t be able to handle what she says to me.” After taking this thought to inquiry, I decided this is how I am walking into the meeting: my job is to show up, be open, ask questions, and the next step will be shown.

Meeting with the surgeon for the 2nd time was like meeting with a different surgeon. She was full of smiles and relief. She was absolutely blown away by my progress with chemo so far ~ I have literally “made her day” and am the success story she is telling many of her other patients. Look! I got exactly what I imagined for this part!

She said that I do have all 3 surgery options, which is great news. But the lumpectomy she described is not what I imagined. She could “try” to do a lumpectomy but she would still need to take out all of the tissue that was originally affected by the cancer to make sure we get clear margins. When she held out a ruler, it looked to be the size of a tennis ball. She said that it would leave my breast with a noticeable deformity and it would not match the other breast. Radiation could also further shrink the breast. Unfortunately, my left breast is already smaller than my right one ~ damnit, universe, why didn’t you cancer up my right boobie instead? I had thought they could put a little extra “fun” in there to even them out but apparently that’s not possible ~ you just get what you get.

It’s confusing for me because according to the latest diagnostic tests, the cancer is already almost gone and it will disappear even more over the next 6 chemo sessions ~ so why take out so much tissue? She says not all cancer cells show up in tests ~ only the microscope can tell so they take out all of the tissue that was originally affected. I asked, “what’s the point of doing 5 months of intense chemo to shrink the tumor if you’re basically going to take out the same amount of tissue anyways?”

Her response: “Think of the tumor as a glass mirror. When I throw it on the ground, it shatters into pieces. This is what the chemo is doing to the tumor ~ we hope that we are getting all of the shards but they tend to spread out. You did have a few satellite nodules too. And I would be taking out less than we would have needed to in the beginning. Remember that cancer is a systemic disease, so the chemo’s main goal is to kill the cancer cells in the entire body, and because we have seen how well your tumors have responded to the chemo, this tells us it is definitely working for the rest of the body too. This is good news! When you first came in and I saw the size of these tumors, I was really, really worried. So this is just amazing to see your response.” With a lumpectomy, there is a slightly greater statistical chance the cancer could come back and/or she may not be able to get clear margins which could mean a 2nd surgery.

I understand her point of view and at the same time, I feel kind of cheated. It seems like if chemo only shrunk the tumor to half its original size, there would still be the same recommendation for surgery? And something I thought of later and will ask her…after cancer treatment when patients are in so-called “remission,” scans are done to make sure the cancer has not come back or spread to another area. When the scans are “clear,” it means there’s no cancer and everyone celebrates ~ they don’t need to take tissue out each time to determine this. So why is it different now?

So it’s not the exact news I wanted to hear and it’s also good that I do have a lot of options. She said a mastectomy is the safest option from her perspective and the plastic surgeon would make sure that the other breast looks even. The chances of cancer coming back are decreased and I wouldn’t need an annual mammogram on my left breast. I’m open to this and will meet with a plastic surgeon soon for a consultation. Some questions for him are: Over time with aging, does my right boob grow down while the other stays up? Creepy. And is it really true there’s nothing you can do to fill in the breast from a lumpectomy?

A double mastectomy is usually what women my age do ~ that way the breasts are both perky and even for life and an annual mammogram is not required. She says it does not increase the survival rate ~ it’s more of an “emotional” decision according to the doctor. I am not a candidate for using body fat to build the breasts (I don’t have enough of it!) so implants would be used.

I’ll also need surgery in my left axilla (armpit) to remove the cancerous lymph nodes and there are 2 few different options for that. One would be a separate surgery but would involve taking out less lymph nodes and the other would be done during the breast surgery and would involve taking out 10-12 (or maybe up to 35). She is open to trying the first option and if more need to be taken out, option 2. My hubby was the one who brought up doing option 1 ~ GO HIM! And GO HER for being open.

I have been taking this all in and it has been emotional. Right now I see bonuses and downsides for all 3 options and I trust at some point, something will stand out as a YES for me. It’s just so crazy I’m even thinking about this!!! It would probably be an easier decision if I didn’t care what my boobs look like or I was super old… but yes, I’ll admit it: I want the sexy bikini yogini bod back 😎. Some people may say that’s vain but that’s how I honestly feel. Since chemo started and I’ve lost weight, I’ve experienced entirely different breasts ~ they’re smaller, kind of long & stringy. It seems similar to how my girlfriends describe their post baby/nursing breasts. Perky boobs for life may not be such a bad idea…

So my next steps are:

  • Keep gathering questions for the surgeon.
  • Visit with a plastic surgeon to get a consultation, see photos, find out what reconstruction could look like.
  • Get a second opinion for doing a lumpectomy (maybe another breast surgeon feels more confident about taking out less tissue so I can keep my natural breasts without a deformity).
  • Talk with other women who have had each type of surgery.
  • Continue to take my stressful thoughts to inquiry: The doctor misled me. She shouldn’t take out so much tissue. I will make the wrong decision. 

Luckily I have plenty of time to find out what feels right for me ~ surgery will be in April (they wait 4-6 weeks after chemo so the body can build its immunity back). A few weeks after surgery, she recommends the standard treatment of 5-6 weeks of radiation (5 days per week) ~ I have thoughts about this too but right now I need to pace out my mind and take things one step at a time.

Right after our meeting, I was standing in the hallway by myself, looking out the window. It was raining heavily and then started to hail. While listening to the Rain Photosoft thumps of hail hitting the floor and metal railings, I was overcome with a comforting feeling of peace and pride. My eyes started to tear up and I just breathed it all in. Damn, even though the meeting went differently than I anticipated, I handled it so well. And I wasn’t trying to be strong, it was a natural happening. And here I am not knowing what my decision is and I’m ok with it. Ok, with not knowing. Cancer is such a great teacher of making peace with the unknown.

I realize it might be crazy to announce this information before I’ve made my decision. There’s part of me that wants to preserve it so that I don’t unintentionally invite in hundreds of other people’s opinions. With so many other opinions floating around (and there have been many throughout this whole process!), it can be hard to hear my own voice. So I want to be clear: I love you and I’m not sharing this information to get your opinion on what I should do for my body.

It can be very easy to have a clear opinion on treatment when you have never been in this situation. I know, because that use to be me. Before I experienced any of this, I would have said, “people are crazy to even consider chemo and to remove a breast or two is even crazier!” Now my mind is open and I see there is no single “right” way of dealing with cancer treatment; this experience has completely humbled me. I don’t know what’s best for anyone else, ever. Treatment is a personal decision and I’ll no longer judge how anyone else chooses their treatment plan. And I am so thankful to have the expertise of these doctors ~ with years and years of experience with cancer cells.

With that said, if you have been through this experience, I would like to hear from you. Are you happy with your surgical decision? How has your life been affected? Would you do anything differently?

I love that I have the opportunity to share a transparent, “real-time” journey of what it’s like to have cancer and be in treatment. I love that I have the courage to do this and it honestly feels so good, so healing, to be so vulnerable. And if it can help just one person find more peace in this process, it’s so worth it.

So here I am, continuing to lay it all out on the table. Moving forward, the info I share may start to get even more “TMI” (can we say, nipple talk?). What I share is my business and what you read is yours, so I’ll leave it up to you!

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