My diagnosis officially was given to me on August 3rd, 2012. Things moved pretty quickly after that. My husband is retired military and we have Tricare military insurance. Living in San Antonio, Texas, the military city of the U.S., I was sent to Brooke Army Medical Center (BAMC) for everything.
I met with the oncology surgeon, Dr. W, for my first appointment on August 7th. We talked about a lumpectomy vs. a mastectomy. A lumpectomy would involve removing about 1/4-1/3 of my breast and there would be a possibility of cancer returning to my breast since I'd still have a portion of it. With a mastectomy, the entire breast would be removed and they would reconstruct at the same time (as long as radiation was not on the table afterwards). Dr. W. said that with either a mastectomy or lumpectomy my breast would not be the same but I would look good in a bra.
Dr. W was pretty straightforward in his approach, didn't pull any punches. Many might say he had no bedside manner, but I appreciated it. Every time we met, I had a list of questions that I had from my research. What are the pros/cons of a lumpectomy vs mastectomy? When would you do radiation vs chemotherapy? Whatever question I thought of, or whatever I found online that generated questions, I asked. No question was too stupid as far as I was concerned. Initially, Dr. W was surprised. I don't think he was offended or anything, I just believe that not many people ask detailed questions and he was surprised that I did.
Anyway, the decision was easy for me. A mastectomy. Two reasons. First, my breasts are pretty small and removing part of one didn't make sense to me. I much preferred lopping it off and starting fresh with a whole new one. Second, and more importantly, I didn't want to risk cancer returning to that breast.
An MRI of both breasts followed on the 14th. There was a tumor <2cm in my left breast, nothing abnormal in the lymph nodes. The right breast had a small mass, 1/2cm (they performed a biopsy on that small mass and found no issue).
I asked if I should have a double mastectomy. He said it was not necessary. I didn't take the BRACA test to determine the likelihood of me getting cancer. Well, I already had cancer and cancer ran in my family so I figured the BRACA wouldn't tell me anything I didn't already know. Given that, I still made the decision to go with a single mastectomy. The likelihood of me getting cancer in my other breast is not high, not any higher than cancer returning to my bones or brain (which could happen even today).
Since the tumor on my left breast was <2cm and was not found in any lymph nodes, Dr. W determined that radiation was highly unlikely and the decision was made to have reconstructive surgery at the same time as the mastectomy.
I met with the plastic surgeon, Dr. C, on August 30th. He was a hoot! He took a picture of my breasts, front and side, chest only, and would throughout...to check his work I guess and make sure the new breast would match the other one? Not sure, but I didn't mind. I later found that he was VERY proud of his work. :)
As with Dr. W, I always went into my appointments with Dr. C carrying a list of questions. He was surprised, too, but always happily answered them. I researched the different types of reconstructive surgery. The two main types that occur at the same time as the mastectomy involve moving tissue to make a new breast. One moves tissue from the back (I forget the name) and the other moves tissue from the abdomen (called Tram Flap Reconstruction). Dr. C told me they only perform Tram Flap reconstructions. He checked my abdomen to make sure I had enough tissue for a new breast. He said there was enough for one not two and was glad when I confirmed that I was only having a single mastectomy.
With tram flap, tissue from the abdomen is moved up (under the skin) to form a new breast. One of the abdominal muscles is redirected to the new breast to provide blood flow. Amazing, right!?! I wonder who first thought to try something like that!!!
Moral - Always ask questions, no matter how many. No question is stupid (except, perhaps, the unasked one)!
Next up: Surgery/Hospital Stay