Bosom:
(noun) the breasts of a woman; the breast, conceived of as the center of feelings or emotion; a state of enclosing intimacy; warm closeness: the bosom of the family.

Sunday, February 26, 2017

Can you spare a nipple? My Surgical Oncology Consultation

It's Monday, Jan. 30th, and I have known for under a week that I have Stage 0 DCIS (confirmed by biopsy).  Today, I met my wonderful Surgical Oncologist, Dr. K. for the first time.  He was just as great as I had been told.  Here's how it went....

After a ton of paperwork....get used to that....I met with the nurse practitioner.  After reviewing my history, she did a quick physical exam before Dr. K came into the room. Typically, Dr. K would have gone over my diagnosis and treatment options in detail...he is often the first person most cancer patients talk to after their diagnosis; however, I had the benefit of having met with the Breast Center Navigator the week before.  This made my visit a little easier and we could pretty much go straight into my surgical options.  He confirmed that no chemotherapy would be called for with Stage 0 DCIS, but that radiation would be required if I chose the lumpectomy route.
Here were my options again (in case you missed my last post):

Option 1: Lumpectomy followed by 5 days/week x 6 weeks of radiation and 5 yrs of hormone suppression medication (leading to menopause symptoms).

Option 2: Left (unilateral) mastectomy and reconstruction followed by 5 yrs of hormone suppression....no radiation.

Option 3: Double mastectomy and reconstruction ....no radiation, no meds

My thoughts:
Option 1:  With a lumpectomy, there is always the possibility that a cancer cell will be left behind.  This is why radiation is necessary.  The thought of having the cancer come back in the same breast or in my other one is scary.  I also did not want to go through the radiation (and all of its side effects) required with a lumpectomy.  The hormone suppression therapy would come with all of the fun of menopause symptoms too.  

Option 2: Once again, the hormone suppression therapy is required in order to protect the right breast that is left behind.  And, again, there is the possibility of breast cancer recurrence in my unaffected breast.  

Option 3: No radiation...no hormone therapy...no more mammograms....no more breast tissue.  While the initial recovery is longer and it is definitely more intense, the outcome would give me the least amount of recurrence risk.

For me, I felt that even the smallest percentage of risk for recurrence was too much for me. 
This included the less than 4% risk included with saving my nipples.  In order to do a "nipple-sparing" procedure, a small amount of breast tissue is left behind....meaning that there is a little something left for those pesky cancer cells to come back to.  Again, not worth it to me and after seeing the amazing work that can be done with plastics and tattooing, I am not at all concerned with losing the nipples too.  

After Dr. K reviewed the statistics for each of the 3 options and then he said to me:  "I will advocate for you whichever option you choose. I will be on your side."  Those are powerful words to hear from anyone, but especially helpful from the physician who is going to be trying to save your life.

After having spent the last week doing my own research, Dr. K was able to confirm what I knew and give me additional info specific to my case.  In the end, I felt very comfortable with my decision and signed consent for a Bilateral (a.k.a. Double) Skin-Sparing Mastectomy with Sentinel Lymph Node Biopsy and possible Lymph Node Dissection.

Image from https://www.cancer.gov/about-cancer/diagnosis-staging/staging/sentinel-node-biopsy-fact-sheet
Because if the breast cancer was going to spread, it would spread via the lymph nodes, a sentinel lymph node biopsy will be performed at the start of my surgery.  The evening before surgery, I will go to the Radiology department of the hospital to have a radioactive tracer dye injected into my lymph nodes.  On the morning of surgery, Dr. K will use this to determine which lymph node is the FIRST one from the cancerous lesion...the sentinel lymph node.  He will remove this node and send it for an immediate biopsy.  If it is clear, he will proceed with the mastectomy as planned.  If it is positive, he will have to remove more lymph nodes for a dissection and further biopsies.  Obviously, this will change my prognosis significantly, as well as my treatment plan.  

There are lots of things to consider as you are making the choice for yourself. Take the time to review all of the info and to research each one.  

The only negative about the appointment was finding out that Dr. K was not going to be available on the date the Breast Center Navigator and I had discussed, so my surgery would likely be later.  Not like this was devastating news or anything, but any extension on the process seemed like forever.

My next appointment was going to be with the Plastic Surgeon, Dr. O, in 9 days.  Assuming things went well with him, the two offices would compare calendars and get me scheduled for surgery.

Still felt surreal leaving that office and the next 9 days went slowly.

MY TIMELINE:
12/22/16  Routine Screening Mammogram
01/18/17  Repeat Imaging and US of left breast; LUMP found.
01/20/17  Core Needle Biopsy
01/24/17  Biopsy results positive...Stage 0 DCIS, left breast
01/25/17  Meeting with Breast Center Navigator and Genetic Testing
01/30/17  Consultation with Surgical Oncologist, Dr. K


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