A Visit with Dr. Bitar

What better way could there be to celebrate my cancerversary week than to have a check-up with my breast surgeon? I haven’t seen Dr. Bitar for close to seven months.  Back then, I was sporting a puffy blue hat and being prepped for my second surgery in just three months. Oh, and I only had one breast.  Just a few hours later, I had two!  (Well, sort of.)

I’ve always thought Dr. Bitar has a great bedside manner and Tuesday’s appointment didn’t disappoint.  She knocked, walked through the door, and enveloped me in a warm, friendly hug. She complimented me on regrowing my hair so quickly after the completion of chemotherapy, and was somewhat surprised when I replied that my hair had never fallen out thanks to the Cold Caps. She had heard of Cold Cap therapy, and was delighted to observe how well it can work.

Next she quickly read through notes from our last couple of interactions, reviewed the results of my recent mammogram, and launched into a physical exam.  She noted the reconstruction had turned out well, and remarked about how my nipple was a transplant to the reconstructed area.  As in, my breast surgeon thought it was my original nipple, not an artistically rendered lump of silicone!  Needless to say, she was stunned and duly impressed when I told her the nipple was actually a prosthesis.

After she completed the physical exam, she suggested that we meet annually and then asked how I would like to proceed with imaging.  As before, my most recent mammogram showed an area of dense tissue, a characteristic typical of younger women’s breasts but also a problematic condition with regards to cancer detection.  My oncologist, Dr. Semien, had regretfully informed me just a few weeks ago that I was ineligible for screening via MRI, as I fulfilled none of the conditions in her list as follows:

1) Screening women at very high genetic risk of breast cancer who are not considering prophylactic mastectomy.

2) To detect mammographically occult breast primary tumor with known axillary nodal adenocarcinoma after negative PE/mammo/US. Current treatment for these women is mastectomy. MRI makes lumpectomy possible for some.

3) To assess patient eligibility for breast-conserving therapy after neoadjuvant chemotherapy when tumor cannot be well evaluated by other methods. MRI must be performed both before and after neoadjuvant chemotherapy.

4) To assess silicone gel breast implant integrity with suspected rupture. (Suspicion based on mammographic, sonographic, or clinical suspicion). Patient otherwise unwilling to consider removal of implant.

5) To evaluate patients with known nipple malignancy (Paget’s disease) and negative mammogram when patient desires breast conservation.

Dr. Bitar added dense breast tissue as a sixth item, thus qualifying me for breast screening via MRI.  I’ll continue to have a mammogram done every March and MRI 6 months later in October.

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