Medical Whiplash

Today I had my first appointment with Dr. Bitar, the breast surgeon who will actually be performing my mastectomy since Dr. Kavanagh is booked through the end of June.  I had the option of doing a phone appointment or office meeting and chose the latter since as a general rule I prefer to meet in person anyone planning on slicing me open.  As usual, I brought a long list of questions, which were mostly clarifications of answers that I had received from Dr. Kavanagh’s fairly optimistic talk with me last week.

We ended up having a lengthy discussion, around 1.5 hrs, and extended through her lunch hour and deep into the next patient’s time slot.  She reviewed my MRI with me, scanning through the cross-sections showing my “large irregularly enhancing mass” (wording from my MRI report), pointing out the locations of the pectoralis muscle wall, lymph nodes, etc.  In addition, she tempered my impression of MRI as a formidable diagnostic tool, connoting less confidence in it than does Dr. Kavanagh.

She is a considerably more conservative clinician in comparison to Dr. Kavanagh.  Whereas Dr. Kavanagh was happy to place a favorable number on the likelihood for DCIS, DCIS-MI, and lymph node invasion, Dr. Bitar simply said that in my case she is very worried about invasive cancer, although DCIS is still a possibility.  When I inquired about my mass “broadly contact[ing] the pectoralis major fascia,” she expressed concern at her being able to cut away a sufficient amount of tissue (muscle or other) in order to create a clear (cancer free) margin completely surrounding my cancer.  If she is unable to create that clear margin, radiation would be required to eradicate any lingering cancer.

Because radiation can damage both skin and fat tissue via shrinkage or burning, its application can jeopardize a completed reconstruction.  Hence, plastic surgeons will generally postpone reconstruction until all radiation therapy is complete.  For me, that could mean a delay of around 6 months between mastectomy and reconstruction.  Contrast this with my current game plan of mastectomy + immediate reconstruction, predicated on the assumption that I will not need radiation.

Dr. Bitar will be contacting Dr. Kavanagh, my radiation oncologist, and my plastic surgeon in the next day to discuss the ramifications of possible issues at the pectoralis boundary.  Furthermore, she will be forwarding my MRI images to another radiologist in South San Francisco to obtain an additional opinion on the tumor’s extent and boundary.

I do have to say that I entered Dr. Bitar’s examination room optimistic but left a bit stunned and considerably more troubled.  However, upon reflection (and after listening to my mother’s and Earl’s sage advice), I realize today’s development can only be a blessing.  The whole point of this invasive, painful, life-altering exercise is to eliminate cancer from my body.  If there is a good chance that reconstruction delay, radiation, and/or chemotherapy are required to achieve that end, I will do whatever is needed.  I just have to get used to the idea first; it’s far better I do that now than after surgery when my options have been reduced.

Incidentally, there is now the possibility that if I delay reconstruction until later in the year, I will move my mastectomy surgery date earlier, perhaps on 6/17 or maybe even before then.  I will be hearing from Dr. Bitar sometime Thurs. (6/2) after she has conferred with her colleagues and inspected her calendar for earlier mastectomy only surgery opportunities, should the medical consensus recommend altering our course.  This would impact travel to Texas, Susan’s Bosom Buddy Walk, and my participation in the Race for the Cure.  I will keep you all posted.


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