Of course, I would rather not have breast cancer (even just this little bitty ‘ol Stage 0), but I do. And, I have treatment choices because women who suffered for years at the hands of surgeons who made decisions for them about treatment (“Hmm, long as we’re here doing the biopsy, let’s just cut off the entire breast so when she wakes up, nothing to think about!”), and women forced more detailed research trials and even got legislatures to mandate shared decision-making between breast cancer patients and their surgeons and oncologists.
I entered my surgeon-of-choice office yesterday armed from reading the best scientific evidence available on treating DCIS (ductal carcinoma in situ), a list of questions, and my partner in tow for moral support and to ask questions that I forgot and as an extra ear to hear what undoubtedly would fly over my discombobulated brain. One hour later I am overwhelmed – no closer to a treatment plan than when I went in except that the choice is truly mine.
First the options:
- Don’t treat.
- Lumpectomy without radiation.
- Lumpectomy with radiation (and various types but only one seems viable).
- Lumpectomy with radiation plus estrogen blocker of some type.
- Mastectomy with or without reconstruction.
- Bilateral mastectomy with or without reconstruction.
No treatment is not an option; so scratch that. I want to survive. The rest of the options do not change survival that much but do influence the risk of breast cancer recurrence slightly. Now the kicker, choices are greatly influenced by my weight loss and resulting tremendously saggy breasts. The one body modification I contemplated upon weight stabilization was some procedure to aesthetically lift the behemoths without scarring that could be a worse trade-off for the sagging. Lumpectomy itself is not that big of a deal, but add radiation and one ends up with a “baby breast” and asymmetry that will be worse than sagging. If I ever decided that I wanted breast reductions, the radiated side would be almost impossible to operate on because of the tissue changes. To remove just one breast is not acceptable to me. Sorry I don’t want to wear a bra just for a prosthesis, and I can’t be bothered attaching one to my chest, AND WHO CAN MATCH MY OTHER DROOPY BOOB? Mastectomies without anything – don’t think my body image could handle that. In fact I know that I could not. Bilateral mastectomy with reconstruction takes 2 surgeries with the associated risks (infection, bleeding, anesthesia, blah, blah, blah). I would have my breasts lifted in a major league way – new boobs of my choosing; overkill for a breast cancer that rarely kills; no nipples but a chance to get tattoos! (Talk about falsies…) Insurance will cover the reconstruction – has to by law. Again, thank you sisters who have gone before me.
I actually sat down and wrote out the pros and cons of each option, including the physical and emotional impact on me and others that I care about. It covers such things as I am scared shitless of surgery (memories of my cholecystectomy linger), have crappy pain tolerance (yes, there are drugs for that), and worry about recovery impact on Sue and her work schedule. At this point, the decision seems obvious. (Bilateral mastectomy with reconstruction.) But why is it so hard? My best friend, who is precious and wise, texted back, “because it is huge and life changing.” Immediately it occurred to me that it is also irreversible.
To make certain that I have all the information available and fully understand the outcomes of choosing reconstruction, my breast surgeon lined me up with a plastic surgeon for tomorrow afternoon. After that I will make my final decision and go forward because there will be no going back.
Did I mention that I was scared shitless?