Monday, December 31, 2012
Pathology Results :-)
"I am pleased to inform you that the pathology from your surgery showed no remaining cancer. This is the best possible result!" . . . direct email quote from my surgeon on 12-11-12. :-) I later found out they tested the "good" one too and there was no cancer their either :-)
Monday, December 10, 2012
Oncoplastic Breast Reduction Surgery
I had surgery on December 4th. The surgery was given several different names - Oncoplastic Breast Reduction, Needle Guided Breast Lumpectomy with reconstruction, breast preservation surgery, etc. Back in April when I was diagnosed I wanted to have a lumpectomy. To me, having a lumpectomy was the best way to still feel like me after cancer. My tumor was considered larger, 3cm (anything over 2cm is considered larger) and if I wanted a lumpectomy I would have to do chemo first to shrink it to a size that can be removed by a lumpectomy. So that is why I did chemo first, also called neo-adjuvant chemo (chemo after surgery is called adjuvant therapy). For me, having nipples (and the areola) was really important . . . the thought of not having nipples (as is the case with most mastectomies) was a scary thought and not something I wanted.
I changed my mind several times and I really did give some thought to having a mastectomy, and even asked my doctor about a nipple sparing mastectomy but she is not comfortable with nipple sparing mastectomies and wont do them so my only choice to save my nipple/areola was to have a lumpectomy. The advantage to doing neoadjuvant chemo is that you can actually feel the tumor getting smaller as you have more chemo. I will say that was an added benefit that I didnt really think about when I made the decision. After talking with several women who had surgery first and were wondering if the chemo was really working, I realized this benefit.
I noticed the tumor was shrinking a few weeks after my first chemo and it continued to shrink while I was on AC chemo. I even got to the point where I didn't really feel it anymore. I did stop feeling my breast after awhile. Then I started having these weird pains, mostly when I woke up and was sleeping on my cancer side. I had similar pains during the first few weeks of chemo and I thought they were the tumor shrinking, but really I have no idea what it was. A few weeks after I declared I could barely feel it I did start to notice other weird differences in my cancer breast compared to my "good" breast. I tried not to freak out about this, with some success, mostly because I stopped feeling it. But there was something else there, and it seemed to move or be a little different each time I felt it. During my first ultrasound I was told I had fat necrosis, or dead fat cells in my breast, likely from when I hit my breast as I was hurriedly going out a door. But there was still something there and whatever it was would be removed during surgery. This also meant that there was a high likelihood I would have a dimple or divot in my breast. My doctors offered me an option - Oncoplastic reduction or basically a lumpectomy with a breast reduction to make them match. After much deliberation I decided to go for this, even thought it meant I was going to cut the good one.
I have never been into big breasts . . . in fact in the past I have wished to have smaller ones but never would have had a reduction unless I was already having surgery on them and thought I would later regret that the they were no longer a similar size. I also only had one shot at this . . . cause with a lumpectomy you have to have radiation to get the same survival rate as a mastectomy and radiated tissue does not heal the same. My plastic surgeon will not do reconstruction on radiated tissue, so it was either now or never. I took the proactive approach and decided to go for it because I thought that later on down the line I would regret that I didnt do it when I had the chance. There is a risk that I will have to have a mastectomy if they dont get clean margins of the tissue surrounding the tumor. This was not a decision that was taken lightly and I worry that I made the right decision.
Prior to starting chemo, they inserted a titanium clip into the tumor so that after chemo has shrunk the tumor to almost nothing that she can still find it and know what tissue to remove. I am a little sketchy on the details of the surgery, but I do know that I had to get a wire inserted into my breast to help with the surgery. That was fun - NOT but I'll go into details later.
I was told to arrive for my surgery at 6:30am . . . the night before and again the morning of surgery I had to wash my chest area with a special soap that was in these scrub thingies. When I looked closer I realized it was the same soap that doctors use to scrub their hands prior to surgery. So that morning I got up and washed again with that soap, which kindof seems redundant cause I just did it hours before, but I'll do anything to prevent infection.
When I showed up they called me back in right away (unlike my SNB where I had to wait), had me get into the lovely paper gown, gripper socks and hairnet. The nurse didnt call it a hairnet, she called it my "party hat" which since I dont really have hair I appreciated that :-). They also started my IV on my battered left hand while noting how beautiful my right hand veins looked. I noted how different things were than when I was there for my SNB in that I am more comfortable with people poking and prodding me and I even knew that my hand was the best place to start an IV Then she allowed my hubby and his Mom to come back and be with me. At 8am I had an appointment in the Ultrasound/Mammogram area. Someone promptly came and took me downstairs to that appointment where I waited in the hallway. This is the same area where I had my inital ultrasound and mammogram so while they left me sitting there to think, not fun.
The ultrasound technican then came and got me and got me ready to do the ultrasound and insert the wire. She then scanned my breast several times and couldnt see the tumor at all so she had to order a mammogram assisted wire insertion. I had a general amoutn of fear at this point . . . but the technican just explained that the wire had to be inserted under mammogram compression and now I was scared. Really scared. And she got me in the wheelchair and put me outside the door to wait for the mammogram room to be available. Oh boy, more time to freak out about my surgery and that I will soon be under mammogram compression for like 10 minutes or so. For those of you lucky enough to never have a mammogram, take your breast and put it between two 2x4 pieces of wood and then clamp them down. Sounds like fun, right? If you have breasts and didnt wince at that analogy then you probably didnt really think about it. Finally the room opened up and they took me in there. I had a regular mammogram, just so I could remember how much it hurt. Then they set up for the real procedure and locked me into the modern day torture device. The technicain was really nice and was trying to make it as painless as possible but it is just a painful procedure. The technican was working wtih the doctor to find the exact location of the clip, this meant that after the mammogram I had to remain under compression for the 90 seconds that it takes for the mammgoram film to develop, for the technican and doctors to look at the film, align the machine, swab me with some sort of antibacterial and then for the doctor to insert a needle and take another mammogram "picture" to make sure that he inserted it in the right place, then insert the wire through the needle, and do some other things, then finally let me go. I was allowed to sit during this time, but I dont remember the final things the doctor did, probably because I was in survival mode to deal with the pain. Oh and I forgot to metion, at some point they did insert some pain meds, but it still hurt.
After all that was done they put me in the wheelchair in the hallway again and called for transport. I guess the transport guy was pretty unhappy cause he was giving the technican attitude when she called and when he picked me up he never said anything to me. As soon as I got back to my preop cubicle there were several doctors and nurses waiting for me and I had to pee. They let me pee but my preop nurse barged in to help me flush and carry my IV.
Then I had a "meeting" in my cubicle with all the doctors . . .the curtain was drawn and the anesthesiologist, general surgon, plastic surgeon and nurse were all in there. It was a party. They were all trying to do their part as quickly as possible to get me in surgery as I think it was already an hour past my scheduled time. The anesthesiologist asked about prior reactions to the aneshesia and if I had any loose teeth. She also mentioned that I may wake up with a sore or dry throat from the tubes. I mentioend that chemo has made my throat dry and she replied then probably you will wake up with a sore throat. She is also pregnant so my only question/comment for her was to please not go into labor during my surgery, ha ha. Then the General Surgeon Initaled my right shoulder area . . . dont want to get those messed up, but since I now had a wire sticking out of that one I thougth it was a low likelihiood that she would get it mixed up. But I am glad that is their policy. Then the Plastic Surgeon went to work marking me up with her marker. She looked at the shape of my breasts and then was looking where the nipple would look best and then looked at each breast differently and tried to think about how the right one would look/change after radiation. She seems like an extremely detail oriented person and I like that in a plastic surgeon.
Then after the docs asked a few more questions, called my hubby in to give me one last kiss they gave me the "happy juice" and yes, that is exactly what they called it (same with my SNB). She inserted something in my IV and it hurt . . .maybe cause my veins are so battered and abused or maybe there was a little clot there. I dont remember anything after that, ha ha.
Then I started waking up. I heard voices but dont remember opening my eyes. I heard a male voice asking me if I was in pain. I had to stop and think about it and yes, I was in pain. I tried to fall back asleep but he was telling me not to fall asleep. When you are coming out of anesthesia you are incredibly obedient, he could have asked me to stand on my head and count backwards from 10 and I would have done it. But really I wanted to fall back asleep. He asked how bad my pain was and I said 5 . .. he asked if I wanted pain meds and I said yes. He then gave me a pill, a little water and made me take a bite of a cracker. Then I fell back asleep. I remember waking up later and I could hear people talking and I think it was my hubby and my Dad. I dont really remember too much as I was coming to but I do know that they were pumping air into my paper gown. I started to wake up but was still groggy. I asked for water cause my throat hurt really badly and felt really dry. I was still in a daze and had all of these people around me - nurses, my hubby, my Dad, hubby's Mom, overload for someone just waking up. I snuck a peak at myself and saw there was this bra on me but that was prettymuch all I saw. The nurse then did some tests and said I could leave when I was ready. I wanted to go home, but I didnt get ready just yet. I dont know how long it was, but I waited a little while then got dressed and ready to go. I wasnt really in any pain but looking back I think I was a little too drowsy to leave. I had a bunch of people help me and of course I got the wheelchair ride to the car. My Dad even gave me some pretty flowers as we were leaving.
The car ride was uneventful and I managed to walk up the three flights of stairs to my place without any trouble. Once home I started to feel hungry. I knew it had been a long time since I ate so I asked for some really easy to digest foods like chicken broth, apple, rice and black beans. They all went down ok but I was getting tired. I also started to have some pain. Since the pain meds normally make me sleepy and I wanted to stay ahead of the pain I took a pain pill then went to the bed. I was playing on my phone for a little bit then decided to close my eyes. Every time I closed my eyes I got dizzy. WTH?? The room would spin like I had too much alcohol, um, I mean so I have heard happens when you have too much alcohol. At this time I also realized I had not peed since surgery and it had been several hours. I had the urge a couple of times but wasnt able to do it. I was starting to get worried.
Despite being tired I couldnt sleep so I went to the living room to watch some tv/play on the computer. Then it hit me. My stomach didnt feel well. I walked to the bathroom. Then I had a feeling I havent felt in years, like I was really going to throw up. Unfortunately the bathroom has a mirror along the wall of the toilet so I could see myself. I did not look good. I gave myself a pep talk that I would not throw up. Then I threw up everything I had eaten while trying to not move my chest too much which is prettymuch impossible. And I missed, not a lot but when we are talking about vomiting missing even a little bit is too much. My stomach felt better though and surprisingly enough my drymouth feeling started to go away. I also went pee afterwards so that was one less thing to worry about.
I watched tv for awhile then went to sleep on my wedge pillow and had an uneventful night. Till I woke up the next morning and I couldnt talk cause my throat hurt so bad. My throat hurt worse than my breasts. My throat was sore from the tubes during surgery. I wanst really hungry but wanted to drink a lot. I had some water, "juice" from black beans and tea. Nothing really helped. Later a nurse told me to suck on ice chips to help with the swelling and then a nurse at my first post op appointment suggested I get Sucrets of Cepacol. We went to CVS right after the visit and got the strongest Cepacol lozenges and they did help tremendously I also ate a couple of popsicles I had left over from my Taxol days too.
All in all I dont feel that bad and surprisingly enough I dont really have any pain. I have the annoying feeling like I am wearing an underwire bra that is digging in, but no real pain more of an inconvenience. And I am happy with the decision to do the oncoplastic reduction cause they are the same size. Now I just need to find out if my margins were clear. I have follow ups with my general surgeon, plastic surgeon and Oncologist this week. If my margins are clear I will then meet with the Radiation doctor to talk about radiation that is required for all lumpectomies to get the same survival as a mastectomy.
Wow, I wrote a book!
I changed my mind several times and I really did give some thought to having a mastectomy, and even asked my doctor about a nipple sparing mastectomy but she is not comfortable with nipple sparing mastectomies and wont do them so my only choice to save my nipple/areola was to have a lumpectomy. The advantage to doing neoadjuvant chemo is that you can actually feel the tumor getting smaller as you have more chemo. I will say that was an added benefit that I didnt really think about when I made the decision. After talking with several women who had surgery first and were wondering if the chemo was really working, I realized this benefit.
I noticed the tumor was shrinking a few weeks after my first chemo and it continued to shrink while I was on AC chemo. I even got to the point where I didn't really feel it anymore. I did stop feeling my breast after awhile. Then I started having these weird pains, mostly when I woke up and was sleeping on my cancer side. I had similar pains during the first few weeks of chemo and I thought they were the tumor shrinking, but really I have no idea what it was. A few weeks after I declared I could barely feel it I did start to notice other weird differences in my cancer breast compared to my "good" breast. I tried not to freak out about this, with some success, mostly because I stopped feeling it. But there was something else there, and it seemed to move or be a little different each time I felt it. During my first ultrasound I was told I had fat necrosis, or dead fat cells in my breast, likely from when I hit my breast as I was hurriedly going out a door. But there was still something there and whatever it was would be removed during surgery. This also meant that there was a high likelihood I would have a dimple or divot in my breast. My doctors offered me an option - Oncoplastic reduction or basically a lumpectomy with a breast reduction to make them match. After much deliberation I decided to go for this, even thought it meant I was going to cut the good one.
I have never been into big breasts . . . in fact in the past I have wished to have smaller ones but never would have had a reduction unless I was already having surgery on them and thought I would later regret that the they were no longer a similar size. I also only had one shot at this . . . cause with a lumpectomy you have to have radiation to get the same survival rate as a mastectomy and radiated tissue does not heal the same. My plastic surgeon will not do reconstruction on radiated tissue, so it was either now or never. I took the proactive approach and decided to go for it because I thought that later on down the line I would regret that I didnt do it when I had the chance. There is a risk that I will have to have a mastectomy if they dont get clean margins of the tissue surrounding the tumor. This was not a decision that was taken lightly and I worry that I made the right decision.
Prior to starting chemo, they inserted a titanium clip into the tumor so that after chemo has shrunk the tumor to almost nothing that she can still find it and know what tissue to remove. I am a little sketchy on the details of the surgery, but I do know that I had to get a wire inserted into my breast to help with the surgery. That was fun - NOT but I'll go into details later.
I was told to arrive for my surgery at 6:30am . . . the night before and again the morning of surgery I had to wash my chest area with a special soap that was in these scrub thingies. When I looked closer I realized it was the same soap that doctors use to scrub their hands prior to surgery. So that morning I got up and washed again with that soap, which kindof seems redundant cause I just did it hours before, but I'll do anything to prevent infection.
When I showed up they called me back in right away (unlike my SNB where I had to wait), had me get into the lovely paper gown, gripper socks and hairnet. The nurse didnt call it a hairnet, she called it my "party hat" which since I dont really have hair I appreciated that :-). They also started my IV on my battered left hand while noting how beautiful my right hand veins looked. I noted how different things were than when I was there for my SNB in that I am more comfortable with people poking and prodding me and I even knew that my hand was the best place to start an IV Then she allowed my hubby and his Mom to come back and be with me. At 8am I had an appointment in the Ultrasound/Mammogram area. Someone promptly came and took me downstairs to that appointment where I waited in the hallway. This is the same area where I had my inital ultrasound and mammogram so while they left me sitting there to think, not fun.
The ultrasound technican then came and got me and got me ready to do the ultrasound and insert the wire. She then scanned my breast several times and couldnt see the tumor at all so she had to order a mammogram assisted wire insertion. I had a general amoutn of fear at this point . . . but the technican just explained that the wire had to be inserted under mammogram compression and now I was scared. Really scared. And she got me in the wheelchair and put me outside the door to wait for the mammogram room to be available. Oh boy, more time to freak out about my surgery and that I will soon be under mammogram compression for like 10 minutes or so. For those of you lucky enough to never have a mammogram, take your breast and put it between two 2x4 pieces of wood and then clamp them down. Sounds like fun, right? If you have breasts and didnt wince at that analogy then you probably didnt really think about it. Finally the room opened up and they took me in there. I had a regular mammogram, just so I could remember how much it hurt. Then they set up for the real procedure and locked me into the modern day torture device. The technicain was really nice and was trying to make it as painless as possible but it is just a painful procedure. The technican was working wtih the doctor to find the exact location of the clip, this meant that after the mammogram I had to remain under compression for the 90 seconds that it takes for the mammgoram film to develop, for the technican and doctors to look at the film, align the machine, swab me with some sort of antibacterial and then for the doctor to insert a needle and take another mammogram "picture" to make sure that he inserted it in the right place, then insert the wire through the needle, and do some other things, then finally let me go. I was allowed to sit during this time, but I dont remember the final things the doctor did, probably because I was in survival mode to deal with the pain. Oh and I forgot to metion, at some point they did insert some pain meds, but it still hurt.
After all that was done they put me in the wheelchair in the hallway again and called for transport. I guess the transport guy was pretty unhappy cause he was giving the technican attitude when she called and when he picked me up he never said anything to me. As soon as I got back to my preop cubicle there were several doctors and nurses waiting for me and I had to pee. They let me pee but my preop nurse barged in to help me flush and carry my IV.
Then I had a "meeting" in my cubicle with all the doctors . . .the curtain was drawn and the anesthesiologist, general surgon, plastic surgeon and nurse were all in there. It was a party. They were all trying to do their part as quickly as possible to get me in surgery as I think it was already an hour past my scheduled time. The anesthesiologist asked about prior reactions to the aneshesia and if I had any loose teeth. She also mentioned that I may wake up with a sore or dry throat from the tubes. I mentioend that chemo has made my throat dry and she replied then probably you will wake up with a sore throat. She is also pregnant so my only question/comment for her was to please not go into labor during my surgery, ha ha. Then the General Surgeon Initaled my right shoulder area . . . dont want to get those messed up, but since I now had a wire sticking out of that one I thougth it was a low likelihiood that she would get it mixed up. But I am glad that is their policy. Then the Plastic Surgeon went to work marking me up with her marker. She looked at the shape of my breasts and then was looking where the nipple would look best and then looked at each breast differently and tried to think about how the right one would look/change after radiation. She seems like an extremely detail oriented person and I like that in a plastic surgeon.
Then after the docs asked a few more questions, called my hubby in to give me one last kiss they gave me the "happy juice" and yes, that is exactly what they called it (same with my SNB). She inserted something in my IV and it hurt . . .maybe cause my veins are so battered and abused or maybe there was a little clot there. I dont remember anything after that, ha ha.
Then I started waking up. I heard voices but dont remember opening my eyes. I heard a male voice asking me if I was in pain. I had to stop and think about it and yes, I was in pain. I tried to fall back asleep but he was telling me not to fall asleep. When you are coming out of anesthesia you are incredibly obedient, he could have asked me to stand on my head and count backwards from 10 and I would have done it. But really I wanted to fall back asleep. He asked how bad my pain was and I said 5 . .. he asked if I wanted pain meds and I said yes. He then gave me a pill, a little water and made me take a bite of a cracker. Then I fell back asleep. I remember waking up later and I could hear people talking and I think it was my hubby and my Dad. I dont really remember too much as I was coming to but I do know that they were pumping air into my paper gown. I started to wake up but was still groggy. I asked for water cause my throat hurt really badly and felt really dry. I was still in a daze and had all of these people around me - nurses, my hubby, my Dad, hubby's Mom, overload for someone just waking up. I snuck a peak at myself and saw there was this bra on me but that was prettymuch all I saw. The nurse then did some tests and said I could leave when I was ready. I wanted to go home, but I didnt get ready just yet. I dont know how long it was, but I waited a little while then got dressed and ready to go. I wasnt really in any pain but looking back I think I was a little too drowsy to leave. I had a bunch of people help me and of course I got the wheelchair ride to the car. My Dad even gave me some pretty flowers as we were leaving.
The car ride was uneventful and I managed to walk up the three flights of stairs to my place without any trouble. Once home I started to feel hungry. I knew it had been a long time since I ate so I asked for some really easy to digest foods like chicken broth, apple, rice and black beans. They all went down ok but I was getting tired. I also started to have some pain. Since the pain meds normally make me sleepy and I wanted to stay ahead of the pain I took a pain pill then went to the bed. I was playing on my phone for a little bit then decided to close my eyes. Every time I closed my eyes I got dizzy. WTH?? The room would spin like I had too much alcohol, um, I mean so I have heard happens when you have too much alcohol. At this time I also realized I had not peed since surgery and it had been several hours. I had the urge a couple of times but wasnt able to do it. I was starting to get worried.
Despite being tired I couldnt sleep so I went to the living room to watch some tv/play on the computer. Then it hit me. My stomach didnt feel well. I walked to the bathroom. Then I had a feeling I havent felt in years, like I was really going to throw up. Unfortunately the bathroom has a mirror along the wall of the toilet so I could see myself. I did not look good. I gave myself a pep talk that I would not throw up. Then I threw up everything I had eaten while trying to not move my chest too much which is prettymuch impossible. And I missed, not a lot but when we are talking about vomiting missing even a little bit is too much. My stomach felt better though and surprisingly enough my drymouth feeling started to go away. I also went pee afterwards so that was one less thing to worry about.
I watched tv for awhile then went to sleep on my wedge pillow and had an uneventful night. Till I woke up the next morning and I couldnt talk cause my throat hurt so bad. My throat hurt worse than my breasts. My throat was sore from the tubes during surgery. I wanst really hungry but wanted to drink a lot. I had some water, "juice" from black beans and tea. Nothing really helped. Later a nurse told me to suck on ice chips to help with the swelling and then a nurse at my first post op appointment suggested I get Sucrets of Cepacol. We went to CVS right after the visit and got the strongest Cepacol lozenges and they did help tremendously I also ate a couple of popsicles I had left over from my Taxol days too.
All in all I dont feel that bad and surprisingly enough I dont really have any pain. I have the annoying feeling like I am wearing an underwire bra that is digging in, but no real pain more of an inconvenience. And I am happy with the decision to do the oncoplastic reduction cause they are the same size. Now I just need to find out if my margins were clear. I have follow ups with my general surgeon, plastic surgeon and Oncologist this week. If my margins are clear I will then meet with the Radiation doctor to talk about radiation that is required for all lumpectomies to get the same survival as a mastectomy.
Wow, I wrote a book!
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