Plastic surgeons are like the Barney Stinsons of the breast cancer world

 
December 28, 2013

Sorry this post is going to be really erratic bc it has been hard to get time to sit at the computer while taking care of both girls (Chris is working sales year-end, so it is me solo, and you all know I am not great at that.)  But I wanted to get an update out there mostly for the Florida family and a few friends who were looking for info on treatment path and timing.  This is a really long post bc it goes through all the treatment options and what I see as the pros and cons and also adult disclaimer – there is detail in here about my current and future boobs so if that makes you uncomfortable then don’t read.

The breast cancer gene test came back negative, thank goodness!!  Which means I am basically in control of my treatment path (to an extent) and can determine what I want to do and in what order.  I am most relieved to not have the gene because I was so worried about Natasha and Karina.  They will still have a higher likelihood of getting breast cancer now that I have had it, but not as high as with the breast cancer gene.  So, yeah, good news in the world of breast cancer.

Now, having options relative to treatment though is actually more stressful than I would’ve expected…I mean they are all scary options, really, all mean a disfigured body and all have different risks, differences in recurrence potential, different amounts and levels of surgery, different follow up plans and potentially additional treatment paths…It’s overwhelming and might be easier if someone was just like – this is what you do to get through this with the best result.  But, and this is a good thing, so much progress has been made with breast cancer that there are options and good options is good news overall.

Since my last update, I got the breast cancer gene results back, met with the oncologist and a plastic surgeon, had an EKG and have had follow up conversations with the cancer surgeon probably 4 times.  (poor thing, she might fire me as her patient, but I have A LOT of questions.)  The oncologist is wonderful.   She gave us a lot of good detail on what to expect with chemotherapy, side effects, duration, etc.  But I have to say the comedic highlight of this experience so far is the plastic surgeon.  Really, all he cares about is how you look after the surgery, which is kind of a nice change when I am so incredibly sick and anxious about losing my hair and eyebrows and eyelashes, not to mention one or both boobs.  So the plastic surgeon is all like hey, so do you want to go bigger? How much bigger?  Well, to be perfect you should do this, and we can improve the other one by doing this, and then throw in a tummy tuck and you will be modeling swimsuits by the end of the year.  Seriously.  He actually said that out loud.  I should probably question his credibility but really, that is his sole aim in life, to make your body look as good as it can after surgery.  For that one hour appointment, we almost entirely forgot about the cancer and were just excited about the potential for my Palos Verdes Mom Body.  (PVMB as we will lovingly refer to it) J  It was an excellent break from all the stress and heart ache.  And we decided (like the title suggests) that he is the Barney Stinson on my team and hope he is able to rebuild my body so that it’s legen..wait for it…dary!

Also, no one on the team is talking about dying.  Which is really good.  Like it’s not even on the radar.  They will have to check my lymph nodes and understand whether their assumption of stage 2 is accurate, but everyone seems to feel really like this is the treatment process to get the cancer OUT and then long term survival should be expected.  I hope that is accurate and not overly optimistic.

If you have any thoughts on treatment, I am totally open to suggestions, tips, thoughts, opinions, resources, references, referrals, whatever, because I am torn on a decision.   I have laid out the options below along with my thought process on risks.  Please feel free to message me if you have any thoughts that might help.

·         First  I have to decide whether I want surgery or chemo first.  If I opt for chemo first then there is a chance they can shrink the tumor down which would enable a more  cosmetically successful lumpectomy, maybe.  It might not. So it’s risky either way, and with a lumpectomy, risk of recurrence is higher than with mastectomy PLUS I would also have to do several months of radiation on the lumpectomy spot.  They have said it is very targeted radiation so while it is like getting an x-ray every day it is only on the one spot and so there are no known health risks, it might burn the skin and cause discomfort.   If I get chemo first, they will also potentially have to over-treat/medicate me bc my HER2 test came back equivocal so they would give me a medicine called Herceptin in my chemo drip and after chemo I would have to continue to take that for some period of time.  Herceptin is a serious drug which has a small risk for causing heart disease, which I may in fact not need.  If I do surgery first then they can send the tumor out for testing again to see if they can get a HER2 positive or negative result and then make a decision on Herceptin based on whether I actually need it.  So I am heavily leaning toward surgery BEFORE chemo.  My only lingering concern is that I will then go into chemo potentially weaker after the surgery AND if the cancer has spread we won’t be treating that for almost 2 months because of the recovery time from surgery.  Any thoughts? 

·         The next thing I need to decide is what kind of surgery I want to have -  lumpectomy, single mastectomy or double mastectomy.  I am, heavily leaning toward a single mastectomy bc I want to reduce my recurrence risk as much as possible, but I also don’t want to go overboard on the medical intervention.  So the tumor they think is 3 cm and they are telling me my boobs are kind of small-ish and so if they took the tumor out without chemo there would be significant loss of tissue and size and I would basically live with half a boob.  Also recurrence is higher with a lumpectomy, so recurrence risk is 5-7% in that same boob as opposed to 2-3% for a mastectomy.  While those are small numbers, it doubles the risk if I have the lumpectomy and I DON’T WANT TO GO THROUGH THIS EVER AGAIN plus I will look weird and have to wear a foob in my boob for the rest of my life.  Plus there is the radiation.  BUT, then I don’t have any other surgical intervention which I kind of like.  With the single mastectomy, the recurrence is lower, but the surgical process sounds like minor massacre and the reconstruction process seriously makes me want to pass out.  I can also choose to have a double mastectomy (I am waiting to find out if that further reduces my recurrence risk) but the second one would be considered basically discretionary surgery and my team is NOT recommending the second one bc I don’t have the cancer gene.  If it greatly reduces my risk for recurrence I will strongly consider that.  Again, totally open to thoughts.

·         Lastly I have to sort out reconstruction options and I have to sort them out before I go into surgery bc the most successful reconstructions will BEGIN at the time of cancer surgery.  I have totally thought about just NOT doing reconstruction and living boobless but everyone who knows me says I will feel sad and abnormal for the rest of my life if I do that, so I am not inclined in that direction but could be influenced if anyone has stories of friends who opted not to reconstruct and are totally fine that way.  My plastic surgeon is recommending implants.  And he would do a tissue expanded in the removed breast and then fill it over time and would also do a lift on the other side and potentially a small implant so I was even and better proportionate than my natural body.  (Only Barney Stinson would be thinking about that in the process of cancer treatment.)  The other option is to do a tissue implant which I might be able to get a different Kaiser facility to do but he thinks I am not a good candidate for the procedure bc I don’t have enough belly fat.  (and I would like to insert a little eff you to the MANY people who have asked me if I am pregnant after having Karina, apparently I am quite fit with regard to fat/muscle on my abdomen, but I have a lot of excess skin from stretching during pregnancy so there!)  So I can go get a second opinion either at the Sunset Kaiser or at this basically like semi-famous place in New Orleans where a coworker referred me and where Angelina Jolie went bc there are now option where  they can take tissue from my belly, back and butt to create real tissue boobs.  The benefit to the tissue surgery is that I guess the boobs look and feel more natural and it is a lifelong solution, like unless there is an issue you don’t ever have to deal with your boobs again, whereas likely implants at some point in  a person’s life are going to need to be replaced.  The tissue surgery though seems excessively intrusive/impactful bc they would have to cut into up to three other body parts to remove the tissue and then they have to connect the tissue with blood vessels and it all seems really like A LOT of surgery and medical intervention.  The other benefit to that though is that you sort of get like a tummy tuck at the same time as a boob job.  I am leaning here toward implants, but of course you guys know I’m a freak and having plastic and saline in my body totally freaks me out too, and there are risks to the implants too, like the tissue still needs to heal.  Plus there is at least one follow up surgery to remove the expanders and really all of the reconstruction sounds disgusting.  And there is some process I’ll have to deal with drains which honestly also makes me want to pass out, so we’ll see how that goes.  Oh also, if Sunset can’t do the tissue surgery and so I would have to go out of network to the New Orleans place I doubt Kaiser would pay for it and we would be talking tens of thousands of dollars out of pocket.  Chris says he doesn’t care bc I have to live with my body for 50+ years hopefully, but I care.  I don’t want my kids to not to go to college bc I had to buy myself the best boobs, or to not be able to move if/when we want bc any extra mortgage contribution went to my boobs.  That would be sad. (BTW, a second opinion at the City of Hope costs $900.  Is that crazy or what???)  I am still going to do it, but f*ck.  That is insane.  I’d prefer to buy a really nice Coach or Kate Spade purse and a Starbucks gift card!)

 

So what does everyone think?  Any magic words of wisdom to help me decide????  I am supposed to go in January 2^nd and schedule out my treatment so I really need to decide by then.

I also wanted to just say that much to my surprise Christmas this year was great.  Maybe it was the weather.  Maybe it was that Tash slept in. I don’t really know, but Chris and I spent the morning creating a table of pros and cons about my treatment path options  (as outlined above) and then the day was like a really cool, fun Christmas and the girls were great.  Because we had failed to make any plans, my parents bought everything for Christmas dinner, brought it over to our house and cooked for us.  It made it feel like a normal holiday and was really generous.  I was so glad because on Christmas Eve, I was feeling so melancholy and bitter, holding back tears all day as I had free time from work to think about the year ahead which by all accounts is going to suck ass.  It was a serious downer of a day.  I mean I am like the holiday queen social coordinator for my family and this year I was like, yah, I don’t really care.  We had no plan for Christmas eve dinner, no plan for Christmas day, I had never felt less merry about Christmas and thought this was going to be the worst Christmas ever.  I am so glad I was wrong.

Thanks again to everyone for reading and for all the calls, IMs, emails, texts checking in on me.  I sincerely appreciate all the love.

Sherri