June 22nd it is. I could have had a simple mastectomy with no reconstruction one week earlier (that was the earliest available), but I declined that option.
My preop appointment is on June 16. I check in at 6.30am on June 22 with my actual surgery starting at 8.30am.
This afternoon, I had a long, very informative (and positive) phone conversation with Dr. Kavanagh. Here are some notes on our discussion (her quotes aren’t exact; I paraphrased extensively). Feel free to skip the rest of this post unless you’re especially interested in the nitty-gritty.
1) Should I be concerned about the 8 week time span from diagnosis to treatment?
“No. Studies [See links at side.] have shown that even a modest wait between breast cancer diagnosis and treatment resulted in no change in prognosis.”
2) Is it possible or likely that there is a >1cm tumor hiding in the right breast that we cannot visualize via mammogram or MRI?
“No. It is very unlikely we will find any masses >1mm. The MRI can find masses down to 1mm in size or smaller and nothing was detected.”
3) If my nodes are positive, is there any reason to not do the reconstruction?
“Based on the MRI, there is maybe a 1% probability of lymph node involvement. If a node is positive, we have to assume there are some foci of invasive cancer. In general, if 4 or more lymph nodes are positive, radiation is very beneficial. So you could decide prior to the surgery that if we find involvement in multiple lymph nodes that we should delay reconstruction until after radiation treatment to prevent radiation damage to reconstruction.”
4) Is there any reason to cancel a prearranged trip to Texas?
“No, as long as you can be contacted by phone during your travel and return by the week or so before the appointment to attend a preop appointment.”
5) The MRI shows the “mass posteriorly broadly contacts the … pectoralis major fascia.” Will you have to resort to a radical mastectomy instead of a simple mastectomy?
“The fascia, which is taken out as a standard of care, forms a natural barrier to the pectoralis muscle. A cancerous penetration of the fascia can be easily seen if present and removed along with a small portion of the muscle adjacent to the penetration to create a clear margin.”
6) The MRI shows “portions of the mass laterally extend just deep to the skin surface.” Is a skin sparing mastectomy still appropriate?
“Yes. I don’t think yours has spread to the skin because you do not exhibit pulling of the skin or other deformities. If it did extend to the skin, we would judiciously remove affected areas as appropriate.”
7) Would you recommend a bilateral mastectomy?
“I don’t think there is cancer in the left breast. It looks clear in the MRI and mammograms. If you are very nervous about it or if the genetic testing came back positive, which is possible since you are young and have a family history of ovarian cancer, it would be an option. It would be possible to change the June 22nd surgery to a bilateral. The advantage to doing the other breast now as opposed to later would be that the TRAM reconstruction can only be done one time. But there are several other reconstruction options available for a later contralateral mastectomy and reconstruction. I do recommend that you follow up on the BRCA testing and try to get those results in before the surgery.”
8) You are unavailable for surgery on the 22nd so Dr. Bitar is scheduled to perform the mastectomy. How should I feel about that?
“Dr. Bitar specializes in Breast Surgery, which consists almost entirely of Breast Oncology. She is phenomenal. If I had to have surgery on my breast, I would have her do it.”
9) Should I consider Oncotype DX for my cancer?
“Oncotype DX is used when invasive cancer is present. We would revisit this after the pathology report comes back post-surgery.”
10) After surgery, how long until I can resume running? Swimming?
“You will have 2 lines of sutures plus 2 drains. You must wait until all of these are removed before immersing your body in water. Furthermore, the TRAM removes muscle (though usually none or next to none) and your plastic surgeon would have to advise you on the appropriate waiting time to allow the muscle to recover to avoid a hernia. This would probably be 4-6 weeks.”
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