It’s happening. Surgery. It’s set and happening. February 3, 2016, I go under the knife.
I saw my breast surgeon, Dr. H, this morning, and as she said, unless something major happens with her or Dr. L, the date is set in stone. I will not see her again until the morning of surgery. I will see Dr. L for his pre-op the week of surgery.
So…what’s happening during surgery? Bilateral skin-sparing mastectomy*. Immediate DIEP* flap reconstruction*. During the mastectomy, I will have a sentinel node biopsy* on the left side, the side confirmed to have cancer. If the sentinel node biopsy comes back clean, no further lymph nodes will be removed. If it comes back showing cancer in the nodes, I will undergo axillary lymph node removal,* which we are hoping does not happen. We are hoping Dr. O, my oncologist, is right and there has been a complete pathological response. We will not know anything about the unknown tumor in the right breast nor will we know for sure there is no cancer in the lymph nodes until the full pathology report is complete, which Dr. H told us will take about a week. Every doctor I have is confident about my response to TCHP*. I’m hoping with all my might they’re all correct.
Surgery is going to be long. Dr. H confirmed what Dr. L told us. It will be between 6-10 hours, and she feels confident it will be on the 10 hour side because I’m having a bilateral mastectomy with immediate reconstruction, and the reconstruction I chose is the most complicated and technical. Dr. H’s part of the surgery, the skin sparing mastectomy, involves Dr. H removing all the breast tissue by separating it from the fat layer between the breast tissue and dermis. Her goal is to remove all the breast tissue, including whatever, if anything, is left of the tumor, and to leave as much as the breast skin in tact as possible. Once she removes all the tissue, she has to reach the sentinel node and examine and remove it. Then, she waits for word from pathology regarding the sentinel node. If the node is clean, her part of surgery is done. If it’s not, she continues with more lymph node removal. Her part of the surgery will take three to four hours. While she ends her part of the surgery, Dr. L begins his part. He starts with tissue harvesting. Once he harvests the tissue from my abdomen, including skin, fat layer, and blood supply, he builds the breast with the tissue he harvested. And, he has to do this for both breasts since I am having a bilateral mastectomy. It involves highly technical micro-vascular surgery. This is not a type of reconstruction offered by all plastic surgeons. It takes a highly skilled plastic surgeon. He has to carefully reconnect the blood supply. If he doesn’t, the skin and tissue die. If they die, the DIEP flap fails. They will know within 24 hours of surgery if the flap failed. If the flaps fail, I have to have more surgery and reconstruction will be delayed for upwards of six months.
I will be in the hospital for a minimum of three days. I will spend at least four weeks recovering, but Dr. H warned me recovery could take as long as eight weeks. She told me I will not be able to stand up straight for at least three weeks. I will not be able to sleep flat for weeks. I will have a minimum of four drains that could be in place for up to two weeks. I will lose my belly button (yes, they’ll replace it). She also told me to expect complications. They’re not uncommon with the surgery I chose. And, I will still need at least two more surgeries after this one. Dr. H warned me it’s likely there will be at least one unplanned surgery depending on how I respond to the initial surgery. The phrase “skin origami” was used several times by both Dr. H and Dr. L to describe part of the surgery. Talk about a phrase no one wants to hear regarding major surgery!
I’ve never been under anesthesia for longer than four hours. I can’t lie, I’m nervous about being under for so long, but I’m not nervous about the surgery anymore. Dr. H and Dr. L are very good. They’ve both done everything to put me, and A, at ease. At this point, it is what it is. I made the choice for a bilateral mastectomy. I made the choice for a DIEP flap reconstruction. I made the best choice for me based off the information I have at my disposal. I’ve talked to friends who are breast cancer survivors. I’ve done my research. I trust my medical team. I’m so grateful to my OBGYN, Dr. B, for helping me and guiding me to the medical team I have. They’re among the best in Dallas for a reason. I trust them. A trusts them. The bilateral mastectomy gives me the best chance to survive. The reconstruction gives me the best chance to feel like me again.
I don’t make decisions easily, and once I make a decision, I tend to doubt myself endlessly. I worry about my decisions endlessly. There are two decisions I haven’t doubted since August: my decision to return to the classroom and my decision to have a bilateral mastectomy.
What I am terrified of is the results of surgery. Results of a new study released recently show that women who have HER2 positive breast cancer have a much higher chance of survival if there is a pathological complete response to neoadjuvant chemo in both the breast and the lymph nodes. The chance of survival is 90% if there is no cancer found in the lymph nodes and no cancer in the breast. That’s what I’m hoping for, and I’m terrified they’re going to find cancer still hanging out. Dr. O doesn’t believe they’ll find cancer left and doesn’t believe it was ever in my lymph nodes. Dr. H did a full clinical breast exam today and said all she feels in the left breast is tough areas she thinks indicate scar tissue of a dead tumor.
I spent a lot of time after I was diagnosed asking A why this was happening to me…what did I do. I felt despair. I felt hopeless. I saw my life ending. I was angry. I was sad. The emotions come and go. I’m scared. If the cancer is still there. If the cancer is in my lymph nodes. I’m not scared of surgery. I’m scared of the results from surgery.
*All links to breastcancer.org and may contain images of surgery, including mastectomy and reconstruction.