Surgery Day

We drove to the hospital as a group.  My bag of what I thought I would need was packed.  Some sweats, a couple zip up hoodies, make up, clean under wear and socks, and my phone charger.  You know if you google labor and delivery bag you can find umpteen lists and tips.  For fun, I googled mastectomy hospital bag.  Yep, nothing of help.  I guess I would wing this one on my own.  For those interested.  I didn't use any of it while I was at the hospital, just an outfit upon discharge and my phone charger. 

We got to the hospital about a 1/2 hour early.  We were greeted by some friendly volunteers, "Welcome to Abbott Northwestern,  do you know where you are needing to be?"  Umm, no, I mean yes.  Radiology registration is where Christa the surgery scheduler told me to go.  We found our way there, guided most of the way by the greeter.  Next to the spa like Piper building, just down the hall.  We found a quiet waiting room and all nervously played on our phones.  At about 10:00, check in time 10:15, I decided to head down to radiology registration and get checked in. 

I decided to go it alone for this part.  No use towing a party of 3 behind me.  Greeted by a young man in vest he found my charts, I signed some papers and was guided down the hall to another waiting room.  I had to get a radioactive shot in my right breast.  This was going to help guide Dr. DJ to the lymph nodes she would take during surgery.  I prayed that she would stop at the sentinel node. 

I waited in the waiting room for what seemed like forever.  Texting Jess, the breast cancer angel, that I was still waiting and getting nervous.  Sam and my parents were still down the hall.  I was ushered back by a kind nurse to again undress from the waist up and get into a gown.  A quick shot of lidocaine, and then some radioactive  material and I was on my way with my plastic bag of belongings. 

We picked up my crew and went down stairs to the preoperative care center together.  Checking in again and then to wait some more.  I was starving and thirsty.  It wasn't long until they called me back.  I had to go back by myself to get prepped.    Undress fully, put on a paper gown, pee in a cup, get hooked up to an awesome heating thing.  There was this box of lights on the wall, when each person came in they would turn off their light.  I had a CRNA student try to place my IV, yea, that didn't work.  But he tried.  Another nurse came in and got an IV started right away to get my fluids started. 

The doctors came in and marked me up.  I think I stated my name and date of birth and procedure about 50 times.  Sam and my parents came back after my IV was placed.  We took a few pictures, Sam got one last peep show, and the CRNA's came in to discuss what was going to happen when I got to the OR.  The CRNA put some medicine in my IV and off we went.  I think I was out before we hit the OR. 

Once Dr. DJ was done with her part, she went out and talked with my family.  She let them know she took the sentinel node and sent it to pathology.  It came back having cancer so she took all 12 nodes under my right arm.  Dr. Kobienia was in doing his part.  This was not what we wanted to hear.  I will for sure need chemo and depending on what the final pathology says, possibly radiation. 

I finally was brought up to my room around 9:00pm.  Apparently there was an emergency on the floor and the nurses couldn't take me yet.  When I was being wheeled down the hall I heard my baby boy saying "momma."  He had finally said this just a few days before.  Sam leaned him in for a kiss.  Best thing ever.  Once in my room, this girl appeared.  It was my sister--umm, what?  I was so confused.  What was she doing here?  She is in dental hygiene school, she can't miss class!!  It was a surprise that apparently everyone knew about except me.  2nd best thing of the day. 

I don't remember who finally told me the cancer was in my nodes.  I cried.  It's never good when the cancer gets in the nodes.  I didn't want to do chemo, I didn't want to lose my hair, I didn't want to be sick.  Real cancer patients have chemo.  I wanted the surgery to fix everything. 

Today's the Day

Today is the the day.   Sam and I had a great day yesterday.  We started the day off as a family.  We went for family pictures; I can't wait to see the images.  Camden then spent the evening with my parents as Sam and I went for dinner and a movie. 

I woke up this morning actually well rested.  I slept about 6 full hours.  Surprising because like most, I don't typically sleep while I'm stressed.  I woke up with a song in my head.  It happens to be a hymn I grew up with, "It is well in my soul."  I think this is God's way of telling me I'm going to be ok. 

I go in about 10:15 so we have only a few hours to get things ready and wrap up a few things around the house.  Of course we will keep you all posted after my surgery.  It's going to be one of the hardest days, but I feel well within my soul. 

The Decision

After the MRI (results are in The Details) Dr. DJ had us come back to her office to talk again about surgery.  This was one week to the day where I was told I had cancer.  I sat in her office staring at her gorgeous hair, not really listening because who really listens after you are told you have cancer. 

Sam and I had talked A LOT about what each surgical option meant and what it meant to us.  I hated that we had to have this talk.  No couple married only 3 years should have this talk.  I think it was probably the most serious conversation we had ever had.  This choice could affect us forever.  We weighed all options and came to a conclusion.  I will lay out the options we are given and go through our thought process. 

Lumpectomy
This is a breast conserving surgery.  The tumor will be removed with enough clear margin--cancer free tissue--and your breast will be sewed back up.  This will leave the breast typically deformed, but you will still have your anatomical breast.  This ALWAYS requires radiation treatment for 5-6 weeks for 5 days per week. 

(Image: http://www.thecancerblog.org/blogs/archives/The-cancer-blog/1160919567-Nov-18-2006.html)
 http://ww5.komen.org/BreastCancer/Lumpectomy.html

Mastectomy
This can be done as either one sided or both.  All of the breast tissue is removed including at least your sentinel node--first lymph node--and possible all of the lymph nodes in your arm pit.  This typically does not require radiation treatment.  This is where plastics comes in.  Reconstruction can be started right after the breast tissue is removed.  Tissue expanders will be placed, so when a woman leaves the hospital she will leave with some breast mound. 
http://ww5.komen.org/BreastCancer/Mastectomy.html

After meeting with the genetic counselor and the plastic surgeon Sam and I felt we had a lot of information to go over together.  We had a lot of pros and cons to go through and we are confident in our decision.  Like most things in marriage, this was a compromise.  We needed to make sure both of our worst fears were eliminated. 

With a lumpectomy the thought of radiation never set well with me.  The plastic surgeon made it known that radiated skin couldn't be reconstructed as well.  The skin is burnt and doesn't stretch as much so adding an implant would be difficult.  I didn't want to stare at a shark bite in the mirror everyday.  Even though this would conserve my breast the chance of reoccurence is higher than mastectomy.  Being a 28 year old woman I have a lot of years for cancer to come back.  The genetic counselor asked us if we were willing to go through this process again; because with a lumpectomy you would be screened and if the cancer came back you would have to do this again. 

With a single mastectomy I would be able to preserve my left breast.  That way if we are blessed with another child after this nightmare is over I could breast feed that child.  Breastfeeding is very important to me.  I breast fed Camden for a year, I have counseled other new moms on breastfeeding issues and successes, and I hoped to one day become a lactation consultant when I was done with nursing school .  I feel strongly that breast milk is the best option for babies.  Leaving breast tissue would leave the door open for cancer to return on the left side and again having our family to go through this process again. 

Double mastectomy I feel gave me an answer to all of my fears.  The chance of reoccurence would decrease.  I wouldn't have to worry about additional screening showing up with more cancer and I wouldn't have to put my family through this again.  The reconstruction options would be the easiest.  Do both at one time and have them matching.  The bad side, I will never be able to breast feed again.  But I will not have to worry about breast cancer coming back.  

I have a lot of years left and the chances of reoccurence is very high for me.  We are still waiting on the genetic BRCA results to come back, but in short, 28 year olds don't typically get cancer.  Sam and I talked and talked and talked some more.  We don't ever want to have to do this again.  This has been hell.  This has been a nightmare.  I go to bed crying and I wake up crying.  I'm scare of uncertainty and I want to be a mother to another baby and I want to be around to be a wife, mother, daughter, and sister for as long as God has planned.  I feel like this will not defeat me.  It may define me and it will test my strength, but I will win.  We asked ourselves if the cancer did come back, what if I didn't find it so quickly? What if it comes back with a vengeance?  What if they can't operate and just take it out?

Our solution and our choice--yes OUR because my breasts are equally mine and my husband's--is to do a bilateral mastectomy with reconstruction.  If my one sacrifice is breastfeeding I will take it.  I will cry and I will be upset when I can't bring my baby to breast to feed him, but I will be alive for him and my family.  

My surgery is scheduled for February 15th.  I'm ready and I will attack this.  I have my team of surgeon's, doctors, friends, families and prayer warriors.  You are all my army behind me and together we will win.   

The Details

So here is the nitty gritty science of what we have going on. 

My tumor--although I don't like to "own" this--is a invasive ductile carcinoma.  This means the tumor started inside the milk ducts of my right breast and started to invade the outlying breast tissue.  (image: http://www.breastcancer.org/symptoms/types/idc)

Normal breast with invasive ductal carcinoma (IDC) in an enlarged cross-section of the duct Breast profile:
A Ducts
B Lobules
C Dilated section of duct to hold milk
D Nipple
E fat
F pectoralis major muscle
G Chest wall/rib cage
Enlargement
A Normal duct cell
B Ductal cancer cells breaking through the basement membrane.
C Basement membrane

The tumor is a grade II on the Nottingham scale--which as I understand means the cells are just slightly mutated.  This is NOT the stage of my cancer.  As of right now the doctors have not given a stage.  I presume this will come after the surgical pathology. 

The biopsy of the lymph tissue came back negative which is great news.  During surgery Dr. DJ will take a lymph node for pathology to determine more. 

My cancer is estrogen and progesterone postive.  This means the "food" the cancer is using to grow is my hormones.  This is actually a good thing.  This way we know where and how the cancer is growing and there is medicine to stop the hormones so the cancer doesn't have food to eat. 

My tumor is 1.7x1.3x1.5 cm.  Relatively this is a very small tumor even though it feels about the size of a bouncy ball in my chest.  (Another reminder to feel your boobs often ladies and men).

I did also have an MRI scan of both breasts to get a better picture of where the cancer was inhabiting.  I will describe more of the experience in another post.  Dr. DJ told me in the MRI they found another lump of about 7mm.  My ducts were also lined with illuminated cells.  They can't prove or disprove there is cancer here unless they were to do a biopsy, but if either area came back cancerous the right breast would be unconservable. 

At this point I don't know if I will need any additional treatment; whether it be radtiation, chemo, or medicine to help attack my cancer.  We will find out this information after my breast tissue is sent to pathology and checked out under the microscope. 

For more information on pathology reports: http://ww5.komen.org/BreastCancer/ContentsofaPathologyReport.html

As more develops I will update the status of the cancer living inside of me.