A post about boobs.

And just like that, only two rounds of chemo to go!

My diagnosis in January feels like yesterday but also a lifetime ago. I remember starting treatment on February 1 and dreading the long chemo road ahead. And now here we are, almost mid-April with four rounds behind me, and starting to think seriously about my surgery options.

***

For something that seemed so far in the distant future, I was surprised how soon my general surgeon recommended that I meet with the plastic surgeon to better understand reconstruction options. So on March 31, 2021, halfway through my treatment schedule, we met.

I wasn't really sure what to expect. I prepared a ton of questions to ask the doctor because I assumed it would just be a 30 minute consultation/conversation. And it was, but what I was not prepared for was the mini photo shoot they wanted to do right away so they could file my pre-surgery and reconstruction upper body. Looking back I guess I shouldn't have been shocked...it was the whole reason I was there, but I was still caught off guard in the moment. So, I did my best to mask my Oh, ok. This is happening-face, pulled my boobs up out of my socks and let them do their thing. (Oh the joys of a post-breastfeeding body.) They really get every angle too. Front, side, left angle, right angle, even my back side. All I could think about while I was standing there was how not-great these images of my post-partum/hasn't-seen-the-sun-in-a-year body looked on a camera...nude. And woof. I could be wrong, but I won't expect any Victoria's Secret modeling contracts to roll in anytime soon.

After my glamour shots, I was able to sit back down with the doctor and he walked me through the pros/cons/recoveries of reconstruction after a lumpectomy (removing only the tumor) vs mastectomy (removing both breasts).

Reconstruction after a lumpectomy sounded like a walk in the park. A quick out-patient procedure; he could lift my breasts up out of my shoes and re-shape easily. A week off work, one month of lifting restrictions.

Reconstruction after the double mastectomy is of course more intense. Implants require a longer process and longer recovery. And while a double mastectomy basically eliminates annual mammograms and the risk of cancer coming back in that area, you're still losing your breasts. You're losing the sensation in your chest. Not to mention, your nipples. And the ability to breastfeed ever again.

As an alternative to implants, you can use your own tummy tissue for reconstruction. Which, initially, I was like, Yes, please - two for one! Tummy tuck and let's perk these babies up! Until the doctor said two things: 1) it's about a 2 month recovery and can be damaging to your stomach muscle lining and 2) "You don't have enough tummy tissue needed for a full reconstruction." And then I had to pick my jaw up off the floor because it was like he basically said I was too skinny to use my own tissue (ah, it's the little things). Ok, Doc - if you say so!

The next steps were for me to reconnect with my general surgeon to reassess the full picture, get her recommendation on what the best case scenario surgery would be, and then decide on reconstruction.

All joking aside, I left the appointment feeling more depressed than I thought I would. First off, I wish the decision between a lumpectomy and mastectomy was easier. I wish there was only one option. Or that 30 doctors would all agree on one and tell me that's what I should do. In the end though, it's going to be a personal decision based on the science and the numbers behind my long-term outlook - not ideal for someone who overthinks basically everything. A lumpectomy sounds like the best option for reconstruction and recovery. And I wouldn't be losing anything (else). But could I live with the anxiety and fear of breast cancer coming back? Or do I just go for the double mastectomy and come to terms with the process and outcome of getting implants?

Radiation also can have negative effects on reconstruction so depending on what type of surgery I choose, that may or may not be a factor. And getting radiation in general is a whole other conversation. Almost everyone I've spoken to is pro-radiation as it supports overall long-term cure rate.

According to my oncologist, a lumpectomy would guarantee radiation as a way to sterilize everything once surgery was done, whereas with a mastectomy, radiation would be up to the radio oncologists once they get the pathology report back on the tissue that's removed during surgery (i.e. it's not necessarily guaranteed the doctors would order radiation). So then I'm back to the question of: if getting radiation is best, am I ok with just a lumpectomy?

*head explodes (again)*

***

I had my fourth chemo infusion on April 5, 2021. Having just met with the plastic surgeon a few days prior, my conversation with my oncologist that morning focused on surgery and what I should do. As amazing as my oncologist is, she wouldn't make a surgery decision for me and told me again that surgery would be a personal choice. She still favors a lumpectomy + radiation. She talked about overall cure rates and differences between the two surgery types, but what really blew my mind was when she said, "Surgery aside, I actually care less about the cancer coming back in your breast. What I care about is blocking a distant cancer. The whole reason I'm giving you this chemo; the whole reason I want to keep you in menopause for the next 3-5 years, and the reasons for the medications you'll take for the next 5-10 years is to keep this cancer from coming back in your liver, lungs or bones." And up until that point, I had never really thought of my treatment in that way. I was strictly focused on not getting breast cancer again. In the end, for my doctor, the type of surgery I choose is much less of a factor than I originally had in my head.

So no definitive answers or decisions yet. I meet with my general surgeon again on April 21st to reassess the big picture. This will be the first time I've seen her since my port surgery, so I'm looking forward to catching up with her and hearing her recommendation based on my treatment progress and outlook.

Chemo #4 went great and this past week was probably the best chemo week I've had. Personally, I think it's because Sadie has been an AMAZING sleeper this week. Our beautiful little hero just turned six months old and continues to be our joy every single day.

...I'll keep you posted on any word from Victoria's Secret.