Surgery Decisions

If you have a choice

Depending on your diagnosis, you may be faced with what may seem like a freedom of choice: lumpectomy or mastectomy. Sometimes, you must have a mastectomy to save your goddamn life. No ifs, ands, or buts. In which case, don't even bother reading the rest of this. In a way, you're lucky, and the decision is made for you. But it's all in how you look at it.

​If you do have a choice; if your tumor or situation is small enough to "conserve the breast," you'll see this phrase a lot: It's an individual decision that only you can make. And it's true. Block out the noise and think truly what is important to you. ​

A.
​Do you care about your boobs, really? Have they served their purpose? Have you had kids already? Do you want them bigger, because they are dinky little boobies as-is? Are they crooked, too big, too small? Will you be incredibly relieved to skip mammograms for all of time?

​Does the thought of looking down at those things make you cringe, a painful reminder of what more havoc they could wreak? 

B.
​Or do you love your nipples and all the sensation that comes along with it? Do you want to save your boob(s) if you have the chance--and see a mastectomy as a severe, no-looking-back route of amputating one or both breasts?

​Are you actually more comfortable with the fact that you'll be having mammograms after you're done with treatment, so that you still continue to feel monitored?

Do you want to see if you get clean margins with a lumpectomy, then have a mastectomy later on in life if the anxiety gets to be too much?

What I did

That left column? When I was first diagnosed, I answered a hearty yes to most of those questions. I figured if breasts are the home base of breast cancer, take them off of me. If I never have to shove my boob into a plastic vise ever again, thank baby Jesus, please just take them off. I don't love my breasts, I thought. I mean they're alright - they're a big B-cup on a good day. But maybe I'll go with a C. Recovery will be long, but that's okay, I can get through it, right?

I sat in the plastic surgeon's office with all the panic of the recent diagnosis still coursing through me. Of course, just take them off, I continued to think, as I stared at photos of rock-hard, strange looking breasts. It's logical. It's the most I can do. I'm young. Maybe they will look natural on me. This decision will ease my anxiety.

Then I had neoadjuvant chemo (a full 15 weeks, with the fertility stuff) before I had to have surgery. This gave me time to think. And trust me, I'm the most surprised at this of everyone - I changed my mind. That ardent need to eradicate myself of the problem breast - the closer I got to the surgery date - lessened. The amputation (and that's what it is) grew more barbaric in my mind. And the more I read about the numbness, the limited range of motion, the long, painful recovery period, the foreign tissue expanders, the rock-hard-ness of reconstructed breasts, the less I was so sure.

I did a complete 180 in the end. I imagined having a child one day, something I wasn't too keen on a couple years ago, but as fertility still continues to be a question mark, is more on my mind. I want to try to breast feed if I ever am blessed to have the chance. Sure, formula is fine and I have no issue with it. But personally, I wanted to have the option to use my breasts as they were intended. Speaking of how they were intended, and sorry if this is TMI - but I love the sensation of my nipples. Having that taken away will be a huge blow.

After speaking very seriously with both my oncologist and surgeon, they agreed lumpectomy - especially with my tumor shrunken as it was - was a viable option. There are no guarantees either way. I could get a mastectomy - double- and it could come back in the chest wall, in the tissue remaining behind it. And how would I know, if I didn't feel it? I wouldn't be getting mammograms. 

Lumpectomy + radiation has the same survival outcomes as a double mastectomy. I know it is hard to make sense of, but it's the truth, and that is what I chose. It's my decision.

What is still to come

Happier, boobier days that someday I will return to.

​Now, I'm writing all of this with my pathology still pending on what they scooped out. In 7-10 days I may be saying, "Oh shit, they need to go back in there and try to get it all." Or I could report that they told me it's way more wild in there than they thought, and then it's the mastectomy route. But that's okay. At least I tried. Because in my mind, at least I didn't go the most severe route and then change my mind about that. wishing I'd at least tried to save my natural sweater puppies.  Because the more I look at 'em nowadays, the more I admire them. They're mine. They're my friends. At least, unless they turn on me again. In which case, I'll be sending them off to a "farm out west."

[Update: Clean Margins, No Node Involvement. We are good to go, knock on wood.]

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