More Details on Change in Surgery

I should fill in some of the details missing from yesterday’s post.

Dr. Bitar has been unable to reach Dr. Kavanagh because she’s on vacation until Monday.  I am interested to hear justification for what appear to be diametrically opposed opinions regarding my case.  Dr. Kavanagh has painted a fairly rosy picture in which DCIS-MI is perhaps the worst diagnosis I should expect, compared to Dr. Bitar who has said the entire 6cm mass viewed on MRI could potentially be invasive cancer.  In accepting the mastectomy + sentinel lymph node only surgery, I am going ahead and  preparing for the far less desirable outcome, fervently hoping for the former, yet expecting a result somewhere in between.

Dr. Bitar had not yet been able to reach another radiologist to get an additional read on my MRI, but she was able to discuss the original MRI report with my other physicians.  Dr. Seaward, my radiation oncologist, agreed there might be a need for radiation given the proximity of my mass to my pectoralis muscle.  And as expected, my plastic surgeon, Dr. Orman, stated the need to delay reconstruction until after any potential radiation.

Conditions which could lead to a recommendation for chemo include the presence of invasive cancer, metastasis in lymph node(s), and tumor size.  Radiation would be required if we can’t get a clear (cancer-free) margin at the pectoralis or if there is metastasis in the lymph nodes.

Dr. Bitar plans to shave an 1/8″ depth from my 1/2″ thick pectoralis muscle in the MRI indicated tumor region to try to create a clear margin.  Furthermore, she will need to judiciously remove tissue in the axilla (armpit) region to create a clear margin on that side of the tumor.  The axilla consists of fat, blood vessels, nerves, and lymph nodes.  Excision from these areas, in contrast to simple breast tissue removal, could lead to lasting motor reduction and swelling.

Whereas my surgery starts at 11.30am on 6/13, I will check in a few hours beforehand in order to receive a weakly radioactive injection which will help Dr. Bitar locate the lymph nodes (using a Geiger counter) to be removed and tested in the sentinel lymph node biopsy portion of my surgery.  I was greatly relieved to hear that Earl will be able to stay with me for most of the period before surgery.

By the way, Dr. Bitar is going above and beyond in accommodating my needs.  Although she was scheduled to be on vacation for a week encompassing 6/13, she voluntarily offered to disrupt her plans to return to work just for my surgery.  What a woman!

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