Tuesdays with Naqvi--The Last Ultrasound and The Surgeries

I had my final ultrasound in this process last week, with the follow up and results yesterday. The miracle of Dr. Naqvi not being able to feel the tumor in an exam was confirmed: no definable mass or lesion with discernable margins could be identified by the ultrasound! My tumor at the first mammogram/ultrasound was 4 1/2 to 5 cm in diameter, large enough to require a mastectomy. After one hell of a chemotherapy experience, it is no longer able to be measured with an ultrasound! There is only a slight change in my axillary lymph nodes, but the cancer cells there weren't originally discovered until after body scan and a second biopsy. I'd say the chemo did its job. How assuring it is to have visual proof of another miracle in my life!

Now that chemo is over, it's time to move on to surgery.

I discussed my options with both my oncologist and my surgeon yesterday, and feel like I have some answers and definitely a plethora of information to think on.

Dr. Naqvi was reluctant to give me her surgical recommendation yesterday; she deals on a cellular and chemical level, and wanted to know the pathology of my tissue before moving forward with her best opinion. She explained that because my initial mammogram and ultrasound showed so many calcifications that are still there, it's hard to know if those areas are precancerous and could later transform into cancer without looking at the pathology of that tissue. Some patients elect a mastectomy, to be done and over with the whole thing, but I could have a lumpectomy to remove the entire area of the original mass, plus extra tissue for study. After the pathology reports came back, we would know the results of my calcifications and have more of an idea of my percent of recurrence. It might be that my entire breast tissue was precancerous, and I would need to move forward with a mastectomy anyway. Or, the results might show that all those calcifications just represent my normal tissue, are benign, and the lumpectomy plus radiation would suffice. If radiation was my choice, one week after surgery, I would start that 6-week process, 5 days a week! I was shocked at the commitment required for that treatment plan and that her desire to have surgery just to discover the pathology of my tissue could end up proving that the other surgery was necessary, anyway. I needed the advice of a surgeon.

Dr. Pollack hasn't seen me for 6 months. I'm on the other side of the big chemo hill, and am ready to move to the next big step. I've also gained 15 pounds since I was last in her office. The nurse said that was normal, and they actually preferred their patients gain weight on chemo than lose it. Go, me! I still had so many surgical questions to ask, so when Dr. Pollack asked what surgery I would like, I told her to explain it all to me as if I knew nothing--the pros and cons of both options, her recommendation, etc.

She started off by telling me that based on my age and the type of cancer, she would recommend a bilateral mastectomy and reconstruction. I have a lot of life left to live, and a lot of time for cancer to come back. With the mastectomy, they are able to remove 97-98% of the breast tissue, which means there is a 97-98% chance that cancer won't return. Plus, I won't need mammograms! Those are some amazing pros! I would have immediate reconstruction, one long surgery, in which they keep most of my breast skin and reconstruct breasts from abdominal tissue. So, I get a boob job and tummy tuck in one! The plastic surgeon takes tissue from my gut and then reattaches the tissue on a micro level, connecting blood vessels. This type of reconstruction looks natural, is my own natural tissue, and lasts forever. In the exam, Dr. Pollack took a look my midsection, seeing a good portion of those extra 15 pounds and said, "yeah, he'll have a lot of tissue to make some nice, big boobies for you!" And that explains one reason they like patients to gain weight during chemo: there's more tissue for the harvest! Who knew I'd be able to find a silver lining in my muffin top? After I heal up, there would be some touch up work and the reconstruction of my nipples, including tattoos. And, here I thought I'd never be inked! The hard part of this procedure is the length of surgery, the 4-5 day hospital stay to drain the sites and watch for complications, and the lengthy 6-8 week post-op recovery time, in which I will have pain, a difficult time being able to get up and stand up straight, or lift anything over 5 pounds. This is NOT a disease for mothers of young children!

My other option is a lumpectomy and radiation. The pros to this were, in her opinion, basically just easier surgery and recovery. The cons of radiation seemed to outweigh the pros. First, my breast tissue would shrink even more, causing me to probably need a reduction on the other breast so it would even out. Also, radiation can cause skin color changes, skin toughening, and scar tissue. Plus, if I chose this treatment and cancer came back, I would require a bilateral mastectomy anyway, and then they would be working with scarred and radiation-damaged skin, instead of healthy tissue. Dr. Pollack was, not surprisingly, anti-radiation and pro-surgery. She is a surgeon, after all! After this meeting I felt like there was really no question as to the best option for me. I just needed to meet with the plastic surgeon to ask a few more questions.