Decisions

Last Monday, Brent and I headed to Spokane to start contemplating my next steps in this whole cancer trip.  Now that I’m almost to the end of the chemical portion of my treatment, I need to start determining what to do on the surgical side to reduce my risk of breast cancer and other cancers occurring (or recurring).  The BRCA1 mutation, and the triple negative breast cancer diagnosis all put me at a higher than average risk to be right back at square 1 fighting cancer, so we headed over the state line to meet with a new round of specialists to talk next steps.

As I had mentioned in an earlier blog I essentially had 3 choices before me (or 3 choices that I was giving myself).  We had already come to the foregone conclusion that I would remove everything that wanted to kill me thanks to my diagnosis.  This means that I will be having a double mastectomy and some form of hysterectomy.  The decision point comes in with the then what?  Meaning do I just accept that those things are gone, heal and move on?  Do I give myself a recovery period, reconstruct and then move on?  Or do I bite the bullet and get everything done up front so I can just focus on recovery?

So last Monday was a day to meet with a new oncology breast surgeon and a plastic surgeon.  I had to meet with a new oncology surgeon because if I decided to do reconstruction at the same time then you need a plastic surgeon and oncology surgeon who can and will work together.  I didn’t have that option in Lewiston, which is why we headed another hour and a half further past to Spokane.  The new surgeon is amazing, and in a lot of ways I wish I would’ve started my treatment out with this office.  I’m not saying I’ve had bad treatment or incorrect treatment, I just felt better in this new place.  Maybe it was the atmosphere, maybe because I haven’t watched someone die there, but I liked it and feel confident going forward with this new surgeon.  She did an outstanding job explaining all over again the entire diagnosis, and in fact did it more in-depth than what I had been given the first time when Brent wasn’t present. So it was great for him to hear it and it was great for me to further understand it while I wasn’t in shut down mode.  She explained how the mastectomy would go, what tissue could and could not be left behind.  She also explained why I may be able to have a hysterectomy at the same time.  I always figured they didn’t do it at the same time because it was just too much stress on your body to do that much surgery.  But in actuality it’s because if they remove your uterus it is then considered a dirty surgery.  I mean we might refer to that part of our body as nasty, but I never really thought of it as dirty.  Go figure, you learn something new every day.  I still have to meet with a gynecological oncologist to determine what type of hysterectomy is best in my situation.  I have heard varying things on this and there is the possibility of only needing to remove the ovaries and fallopian tubes.  Reason for that is I’m more susceptible to have ovarian cancer thanks to the BRCA1 gene but I have no increased risk of uterine cancer.  After our discussion with her, and a little exchange about her time in Milwaukee, we headed back out into the grey, dreary January day and drove the 3 blocks to the next doctor.

So the first doctor’s office was like every doctor’s office you’ve been in.  Somewhat clinical, a little depressing (I mean it’s filled with sick people and folks with cancer and whatnot!), pretty blah.  Well let me tell you that a plastic surgeon’s office is NOTHING like that.  I felt like we walked out of Spokane and in to L.A.  Bright, light, modern, rock music playing in the background and this is where all the dark haired beautiful people come to work. Talk about feeling really old, fat and bald – this place takes a hit on your feelings about your personal image.  But we were there for a very serious reason so I didn’t care that my BMI was probably 3 times that of anyone else there, or my natural hair color is blond (because you obviously need to be brunette to be here) and that I was twice the age of almost everyone working there. The plastic surgeon was exactly like I imagined a plastic surgeon would be.  Cocky, arrogant, metrosexual, oozing confidence.  But to be honest, I kinda want that in a plastic surgeon, someone who knows what they are doing, knows what’s going to look best, and isn’t afraid to tell you that.  I’m not here to get my ego stroked, I’m here to look somewhat normal when this whole process is behind me. So this new doctor went forward and laid out the 3 options I already had for myself.  But he orated what I was internalizing.  That not doing reconstruction would look weird on me.  I’ve been a big girl (still am) both up top and with curves in the mid section, and to go with curvy hips and a belly to flat on top would just look odd.  I could do bra inserts but everyone he ever dealt with after 2 years was back in wanting reconstruction because they were tired of having to stuff their bras, the inserts would snowman on them (meaning shift during the day until one was over the other), they got hot and heavy and they missed looking in the mirror at a more natural shape.  So that got me narrowed down to 2 options, reconstruct immediately or wait (either 1 week or 3 months).  So that you aren’t reading for hours I’ll cut to the chase, Brent and I came to the conclusion that I didn’t want to wait 3 months and then start the recovery process all over.   Regardless, I have to have the mastectomy within 3-4 weeks of chemo ending to reduce the risk of recurrence (especially considering I’m not doing radiation). So that left me with immediate reconstruction or giving myself 1 extra week post-mastectomy to recover from the effects of chemo (reduced red blood count).  I felt like the doctor really wanted me to wait that week but I didn’t feel I would gain anything.  My body would be beaten down from a major surgery, I would be spending 3.5 hours in a vehicle each way which would take a toll on my body, and 1 week just doesn’t seem like it would be earth shattering in terms of my body recovering all that much more.  So I called my oncology doctor’s nurse and asked her point blank her opinion on the matter.  And just like the plastic surgeon, I’ve grown to like her because she just tells it like it is and orates what my gut is telling me.  And that was that he was pushing for the delay more for his convenience than mine.  So with that information in hand we have made the decision to do everything at once (hopefully). It is a very long surgery, and it will be a very long recovery.  But it is what is best for me.  So if you are reading this facing the same decisions you might make a very different one for a variety of reasons.  Mine range from distance to treatment, work considerations, financial considerations, personal patience and preference, and desired recovery timelines.

The last choice to make was whether to go with implants or use my own body material (belly fat) to rebuild the girls.  This is where being fat is finally paying off! We decided to go with the tummy tuck/body fat option because it will age with me and they will be able to contour it to look most like my natural shape.  And I get a tummy tuck (finally a silver lining in this whole cancer thing). Since we are using my own tissue, it will grow and shrink as I do rather than at age 60 having these perky firm things when everything else is starting to sag.  I’ve heard from several folks who know someone that went through with that and at an “older” age it just started to look weird.  And we all know I look weird enough to start off with, I don’t need to add in any extras as I age.

So decisions have been made and surgery is being scheduled for the middle of February.  I’m excited to just start getting through these chapters quickly.  Yes, I will admit I am the person who might flip to the last chapter to see what is going to happen (patience is not a virtue I posses).  But I am ready to start being in recovery mode rather than treatment mode.   Bring on the surgery!! Last decision to make now is if I should power watch nip/tuck during my last chemo recovery period.