It’s 8.00pm on a Thursday night and my phone rings. It’s my surgeon letting me know that today’s CT scan of my brain was clear. I now officially have no signs of metastatic cancer. Woohooo!
She then spends half an hour talking about my prognosis, my surgery and my decisions.
She has confirmed that this type of local recurrence is very rare. She’s only seen it once before and that was with someone that had significant lymph node invasion (and I had none). She’s shocked.
We talked about the multidisciplinary team that she is a part of and how they all agreed that mastectomy was the best option. I don’t know if multidisciplinary teams are in operation everywhere else but what an excellent way to support difficult decision making by caring professionals. Apart from giving me greater confidence in my surgeon’s recommendations, it must be so much better for them to be able to discuss cases with each other. Kylie tells me they don’t always agree. That’s a healthy sign.
I am overjoyed to report that my mitotic rate is the same; 20 over 10 fields. This matters because it means that the cancer hasn’t mutated into something more aggressive. It’s likely I have ‘radiotherapy resistant tissue’ which just gives me one more reason to have it removed.
I was concerned that there may be some argument for retaining the healthy breast. Perhaps having some breast tissue to catch or attract any travelling cancer cells would help to avoid it metastasising in another part of my body. Kylie assures me this is not the case. It’s likely given my lack of node involvement that this cancer hasn’t figured out how to grow in anything other than breast tissue. No breast tissue should, therefore, equal no more cancer.
There’s an option to keep the healthy breast. It turns out that it’s rare for cancer to spread to the second breast and it usually occurs where there’s been clearance of lymph nodes and the remaining lymphatic system is draining to the healthy breast. That’s not my situation. Even so, I’d like it removed. Psychologically, I will always be worried about recurrence. I’d have to keep having mammograms and ultrasounds. I’d also have one very large breast. Aesthetically and physiologically I think I’d rather just have a smooth chest.
I’d also like to avoid the possibility of having to have the second breast removed at a later time, remote though that possibility may be.
Kylie has arranged an appointment for me tomorrow with a breast reconstruction surgeon. Another brilliant doctor. I’m reasonably sure that I don’t want reconstruction. There are lots of reasons. I’m an active person. I love my yoga and my gardening, and my kayaking. The thought of not being able to do these for several months is distressing. Kylie tells me that I can probably be back to gentle yoga in three weeks if I don’t have reconstruction. Full recovery from reconstruction takes about six months.
I’m also squeamish about the idea of cutting away a flap of skin, fat and muscle from my tummy and moving it up to my chest. Eeew. This is clever stuff and has given many women a very happy result. I’m not knocking it. I just don’t think it’s for me. I like my tummy. Yes, it’s a little bit rounded and soft but I like it that way. I can’t have silicone implants after having radiotherapy so using another part of my body to make ‘breast mounds’ would be my only option. The procedure can be done at the same time as a mastectomy and the whole of this takes ten or eleven hours.
I can honestly say that not having breasts isn’t going to be devastating for me. I will be sad. I have lovely breasts and I will miss them. But one of them is trying to kill me.
I talked it over with my amazing husband, Graham. Of course he’s all for saving my life and going ahead with a mastectomy. No question. He’s not keen on reconstruction either. I think he put it well. “Have the least surgery you can.” I’m still going to see the specialist because I don’t think you can have too much information in a situation like this (also Graham’s thinking). I’m allowing for the possibility that I might change my mind in the future. A mastectomy now doesn’t close the door on reconstruction later. Also, from Kylie’s description, this doctor is the kind of woman I like to spend time with. She’s blunt, down to earth and plain speaking.
I’m tentatively booked in for a bilateral mastectomy on the 8th of August. I don’t think I’ll change my mind about reconstruction tomorrow but we’ll see.
Meanwhile I’m overwhelmed with gratitude for my beautiful surgeon who takes time out from her husband and her three little children to spend half an hour talking on the phone to me.
And no charge for that service by the way.
Who does that?
Now if only I could type her name without thinking of hot pants and mirror balls.