I love the above quote by Dallin H. Oaks. We need to be able to look at our choices and determine which one is correct by looking at the alternatives and pondering where each choice will lead.
November 10th
I had appointments with both of my surgeons today. The cancer surgeon and the plastic surgeon. I knew before going to my appointments that I was going to have some major choices to make in a relatively small amount of time. I wanted to go into the the surgeons with an open mind and listen to all my options. The prayer I kept praying was that after talking to the surgeon's, my path would be clear. I just wanted to know with a surety that I was making the best decision for me. I didn't want to have any doubts.
Cancer Surgeon Appointment:
My first appointment was with the cancer surgeon. She is seriously the BEST! The first part of my appointment was going over medical history and a breast exam. She said, "Yeah, I feel nothing. No lump, no mass, nothing that would indicate cancer." I am not sure why, but that made me feel better...like maybe I wasn't some idiot who missed something that should have been obvious! She also did an ultrasound and said that she saw healthy lymph nodes, which also gave me comfort. (Obviously, there is not a guarantee that they are 100% healthy until we get them under a microscope, but it was encouraging that she felt like what she could see was healthy.)
The second part of my appointment was going over options. This was the part that made me nervous. How was I going to make this decision?
My 3 options were:
- Lumpectomy (which, due to the location, consisted of removing the cancer and most likely the nipple) + 4 weeks of radiation (everyday M-F) + Tamoxifen (A drug I would need to take for 5-10 years that basically puts you into early menopause because it suppresses the amount of estrogen in my body. My cancer is ER and PR positive which means it responds and grows with the female hormones estrogen and progesterone. The Tamoxifen suppresses those hormones so cancer doesn't grow back in the same spot or in other breast tissue.
- Right breast single mastectomy + Tamoxifen for 5-10 years (to reduce the risk of cancer coming back in the other breast.)
- Bi-lateral Mastectomy (remove both breasts) + No radiation + No Tamoxifen
Each of these equations equal Cancer Free. Not one choice was better than the other as far as a cure. Great. On one hand this is fantastic news and I am seriously doing a happy dance! On the other hand what's the tipping point? What is the determining factor on which choice to make?
We went over each option and the pros and cons of both. I was able to throw out a single mastectomy pretty fast because I felt like, if I was going to have the surgery, I would just do it once and have it be done. So then it became a choice of doing the smaller lumpectomy vs. the double mastectomy. I kept vacillating between both decisions.
The lumpectomy was a much smaller surgery and is an easier recovery. I also got to keep both my breasts. I would have mammograms very regularly and would be watched like a hawk to make sure that the cancer hadn't returned to the same spot or started to grow on the other side. I would not have to have more surgeries down the road for reconstruction. However, doing radiation did not sound great (it's especially hard on fair skin) and putting myself into early menopause at 41 for the next 5-10 years didn't sound like a cake walk either.
The double mastectomy felt like I was throwing the A-bomb at something small. Like I was bringing a bazooka to a knife fight! I kept thinking, "I really have to lose both of my breasts because of some tiny unfelt calcifications?" Although, if I do that, no more mammograms, no early menopause, no future breast cancer to have to worry about.
I hadn't fully made up my mind but I was definitely leaning towards the double mastectomy for a couple of reasons. First, we already have one parent worried about cancer coming back, we don't need two. Second, I don't want to have to go through this again. Not just the physicality of things but mentally I don't want to worry every time I get a mammogram. I don't want to have to hold my breath worried that they will find something again. I don't want to worry that I might just end up right back here in this spot. We already know that my body grows cancer, why tempt it to do so? Third, if it did come back and I had to go through this again, the radiation could have damaged my skin making a reconstruction very difficult or not possible at all.
As we were mulling it over, Kaden asked the Dr the best question! He said, "If this were your sister, and you had to advise her, which one of these two options would you tell her to do?" The Dr. thought about it for a second, took a pause and said, "You know, I don't normally do this, because either decision is the correct one, but if you are asking what I would say to my sister? I would probably steer her in the direction of the double mastectomy. If she had cancer and was young like you, I would say, get it done and then a year from now you can have it behind you in the rearview mirror." She continued, "Now, if she was a 70 year old woman, our conversation and my recommendation would be different."
That was it. The sealing deal. Once she said that, it was like a lightbulb went off and my decision was clear. I was going to have the double mastectomy.
The Dr. said that we would get things scheduled after I talked to the plastic surgeon since they had to coordinate their schedules for the O.R. time. She also said that that if I scheduled the double mastectomy, but then changed my mind that was ok too. She said, "People change their minds all the time, so don't feel bad if you do too. It is perfectly acceptable." She told me that it was easier to make sure the insurance would cover the bigger surgery and then have to back off rather than schedule the smaller surgery and have to try to get a bigger one approved last minute.
We thanked her and headed next door to the plastic surgeon.
Plastic Surgeon Appointment:
The plastic surgeons office was...weird. I really don't know what I was expecting, but going in and talking about reconstruction, expanders, and implants was all very overwhelming. It's like the Wizard of Oz where they are walking into the unknown forrest saying, "Lions and Tigers and Bears! Oh my!" Except I was saying, "Reconstruction, Expanders, and Implants! Oh my!"
Like Dorothy, I am on a very unfamiliar road heading into territory that makes me anxious and fearful. I have nothing against plastic surgery, I just never really thought it was an option for me. Not because I wouldn't want it, but because I am very cheap. I would always think, "I could have a tummy tuck, or I could get my wood floors installed." And the wood floors would win. I'm still waiting to pull the trigger on that one though. (See? Cheap.)
Anyway, the basic gist of this, which I am sure I will describe better in another post, is that the plastic surgeon will be there at the time of my mastectomy. The cancer surgeon will do the mastectomy on the side with the cancer while the plastic surgeon performs the "prophylactic mastectomy" on the other side. The plastic surgeon will then place a mesh in the shape of a bra cup and expanders under my remaining skin and fill them a bit with air and close me up. Over the next few months I will go into his office every couple of weeks to get more air in them until I get expanded to the desired size.
Now...Let the jokes ensue! Honestly, all I could think of was the old Reebok commercials where they had the pump shoe! The other thing that came to mind was the Chris Rock SNL skit with pumping up the turkey! "Pump it, pump it up! Make it big now." Ha ha!
https://www.youtube.com/watch?v=Pdd0jUnPz-M&ab_channel=SaturdayNightLive
