Saturday, September 15, 2007

The Dog & Pony Show Continues

It's been crunch time this week. I learned the results of my MRI. It showed no other areas of cancer; however, there are several areas that are "probably benign." This means I would need to be followed very closely over the next several years to see if they progress to cancer. I also met with the plastic surgeon; the last team member I needed to meet with before "having all of the information to make my decision." He explained the options if I were to choose mastectomy. First, they could place an implant. This is a shorter surgery (about 6 hours,) but it is done in stages. They put something called an expander in and over time they slowly increase the size. Once the skin is stretched to the final size they place the permanent implant. This could be either saline (not as natural feeling) or silicone (more natural feeling, but saddled with a bad reputation for causing auto-immune problems. Studies have yet to prove the link.) I'll just go on record here by saying I'm not keen on the idea of having a foreign body in my body if I can help it.

We also discussed another option called a DIEP Flap for Deep Inferior Epigastric Perforator Flap. They take the "belly fat"-- I just hate that term. I've lived in blissful denial for YEARS that I possess any "belly fat!" Anyway, they surgically remove the belly fat and skin carefully severing the arteries and veins. The remaining skin is stretched down and reattached (basically a tummy tuck.) The fat is shaped and inserted into the cavity where the breast tissue has been removed. They carefully reattach the veins and arteries. This is a very delicate, very time consuming surgery because they are using microscopes to reattach all of the vessels. This surgery can take up to 12 hours. I may be a candidate for what they call "skin sparing" where they cut out a small keyhole of skin around the breast and remove the tissue from that small hole. There is also a procedure that is "nipple sparing" but they are not yet sure if I am a candidate for that. The benefits of skin- and nipple-sparing are obvious. I get to keep as much of the external tissue as possible. While the belly skin and fat is most like breast skin and fat, there can be pigment differences. And no, I asked if they could take it from my butt and the tissue just isn't right... Bummer!

Every physician and healthcare worker I've talked to has said that this is a very individual choice. And there is no wrong decision. So over the last few days, I've been weighing all of the pro's and con's for me, my family, my lifestyle. Every single woman that goes through this likely goes through the same process, but with a million different reasons for the outcome. I've considered my future risks and my situation with my mom right now. I've chosen to have a double mastectomy with DIEP Flap reconstruction. My heart and mind are one on this decision and I'm at peace with it.

I know I don't need to justify my decision because I'm the one that ultimately needs to live with it, but I will share my thought process if for no other reason than to provide insight to other women that may go through this. First, I am a woman which is the biggest risk factor I have. I'm white (yes, a surprise to many I'm sure...) White women are more likely to get the disease while black women are more likely to die from the disease. I have been diagnosed with breast cancer. My chances of recurrence are higher now that a woman who's never been diagnosed. I have a family history of breast cancer which raises my risk as well. I have several other areas of concern (the "probably benign" areas.) I've been diagnosed at a much younger than the average woman so I have at least half of my life expectancy to live. My chances of recurrence go up 1% of every year after my diagnosis. If I live to be 80 I'll have a 40% chance that breast cancer may return. Also, I'm young, in relatively good shape and can physically handle a lengthy surgery better now than later in life. If I ended up having a recurrence at age 65 and need a mastectomy it will most likely take me much longer to recover. In all honesty, I just want it out! I want to live with as much peace of mind as possible. A double mastectomy gives me the greatest decrease in risk and that's what I want.

One in eight women will be diagnosed with breast cancer. That means several of you reading this WILL be diagnosed. Please, please get screened! Do self breast exams! Get mammograms starting at age 40! Encourage your mothers, sisters, wives, and friends to do so! There is NO excuse not to. Insurances cover it and if they don't there are resources (I'll provide that information in a future blog.) Since I've been diagnosed I've been able to convince 6 women to get their mammograms. If every person reading this convinces just 5 women to get screened and they convince 5 women I feel like I will have made an impact. This is a curable disease if caught early and a very treatable disease if not caught early.

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