Surgery

The game plan for treatment involved surgery first, and "we will see" after we get the pathology of the tissue removed during surgery.  I was initially scheduled for surgery on April 18, but I have done such a wonderful job of teaching my children to share, that they shared their icky colds with me and so I had to postpone to the next week.

The purpose of the surgery was to remove not only the mass, but also the calcifications, because the surgeon felt that those were most likely tiny dots of c. All of that measured 7 x 6 x 4 cm, and if you've ever seen me, you know that I didn't have that much to spare in that region, so it was never a question of lumpectomy vs mastectomy. 

On April 25, I had a single mastectomy on the right side, along with a sentinal lymph node biopsy, and the beginnings of reconstruction.  My breast surgeon, Dr. Lim, was able to achieve negative margins all around. That's good - it means all the edges of what she took were clear for c. She also took three lymph nodes, including the sentinel node and the nearest two, to sample.  During surgery, they did a quick look under a microscope and saw c in one of the lymph nodes.  This means that the DCIS had changed again and that there was at least some invasive c present, but we wouldn't know how much until final pathology results were back.

As a result of seeing c in a lymph node, the surgeons switched gears mid-surgery and put in a tissue expander. This is sort of like an implant, but they can change the amount of saline that goes into it. They did this, because having c in a lymph node means I'll do radiation after I recover from surgery, and the expander is, I guess you could say, the most durable temporary reconstructive measure they can do. Our initial plan had been to do a more permanent reconstruction technique called DIEP that I'll explain another time, but it uses abdominal tissue to rebuild a breast. But, that's not compatible with radiation, so we will do that down the road.

They sent all of the tissue they removed, and the three lymph nodes, and looked through all of it to see what exactly was going on in there. Final pathology came back today, and was almost all great news. 

1 - All margins were negative - meaning, no more surgery will be needed to take c that they "missed" around the edges.

2 - Still only one node had any c, which is great news and means they won't do any additional surgery to remove more lymph nodes. Removing lots of lymph nodes can lead to arm swelling and discomfort, called lymphadema.

3 - Most of the c they found when examining all of the tissue was DCIS - there were only very tiny dots of invasive c, measuring 3mm, 1.2mm, etc. So, that is good news in that there wasn't much invasive - we knew right after surgery that there was at least some invasive, because of the lymph node, so hearing that there's not much is a good thing.

4 - They tested the c for "markers" which helps them understand the biology of it, and therefore how to treat it. This is Estrogen Receptor (ER), Progestin Receptor (PR), and HER2 positive. This one is tricky... having all three receptors positive means it's a more aggressive form of c, but also means that it will respond better to chemo.

I'm feeling really good post surgery.  Less than a week, and I'm off of my pain medicine and just in the "uncomfortable" stage. I can't lift my right arm higher than 45 degrees, and I can't lift more than 7 pounds (have you seen my two kids? they're considerably more than 7 pounds!), and I have two drains which kind of gross me out. But, I'm feeling better each day, and I'm blown away by how kind and helpful everyone has been. I'm bummed that we're looking at radiation and chemo, because initially my oncologist had thought we'd just need to do surgery and then be done. But God is good, and He's got this under control. I'm just along for the ride.