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Monday, December 7, 2009

After the discussion with the radiation onco and to stop Debbie from feeling like a stalker...

I know I've been negligent with the most recent update after Friday's meeting with the radiation onco. For that I apologize.

For starters, he looks like he's maybe 16, complete with tousled hair. That was rather disconcerting. Perhaps, though, his youth is working in my favor.

The previous week, the surgeon gave me some rather sobering arguments for delaying reconstruction until the completion of radiation. Basically, she argued that inserting a tissue expander on the side being radiated could, not necessarily would but clearly could, interfere with treating the cancer. Clearly that is not something that I want. After talking with her, I was almost convinced to just not do reconstruction at all, since after radiation treatments, an implant is not a possibility on the radiated side and I'm not willing to sacrifice my abdominal muscle and the very real potential for other complications from that down the road. I plan on being in this body for quite a few years yet, and it doesn't seem logical to set myself up for a lifetime of back and abdomen issues just to get a boob. For me, the only logical option for reconstruction is implants. There is a much less risky type of "own tissue" reconstruction, the diep flap. However, I can't get two breasts out of my own flesh according to the plastic surgeon (which I think simply can't be true....I am certain I have enough fat for two boobies) and I don't want one breast built one way and the other built a different way. There is a possibility that some tissue from my back could be used but that is yet another incision site and carries its own surgical risks. Call me wimpy, but slicing up my body doesn't sound like fun. Here is an overview of my options. Yes, a tummy tuck would be nice, but at what expense? Weeks and weeks of recovery for that incision alone.

My ideal would be two fake boobies.

The radiation onco was clear that having a tissue expander would not be ideal during radiation, but that it would not negatively affect the benefits of radiation. It would not change the treatment of the cancer. What it does do is make his job harder. Cry me a river, Doogie. It may increase the amount of radiation to my lung and heart, which may increase my risk of short term complications (a type of pneumonia that is fairly rare) and long term risk of heart disease (but not significantly). I figure the former can be treated and the latter will be offset by changes in lifestyle. He seemed to agree.

Of course, there is also the chance that the implant won't survive the radiation. According to most studies, about 50% do survive. If it survives, an implant is easy to do. Having undergone radiation, there is a higher risk of capsular contracture, but that is fixable. And it may not happen.

Once I mentioned that I wasn't shooting for huge boobs, that the tissue expanders wouldn't be any larger than what I already have and may even be smaller, he was much more amenable to the idea. Remember, my reward--other than survival--is to never have to wear a bra if I don't want to for the rest of my life.

I had my MRI this morning. That will decide if I move on to surgery next week (which is what really for pragmatic reasons needs to happen) or if I do more chemo first. People have been asking why doing as much as possible to eliminate the tumor before surgery is necessary and I finally got an answer to that: because of where the tumor is located. The absolute smaller it is, the better the chance the surgeon will get the all important "clear margins". It would be different if the tumor were in the middle of my breast tissue, but it is in the breast fold, on top of a rib, near the edge of the breast. The smaller the tumor, the larger the possibility for clear margins.

Hopefully, I'll get good news later this week. I need some. I need to have surgery next week. Otherwise, I'll be doing that at a very inconvenient time. It really just needs to happen now.


Anonymous said...

Thanks for the update, Dawn. I had been wondering what "the plan" was. Love the big boobs link. I, too, am in the discussion this week of what to do about a boob, except I am post-radiation. Keep us informed, especially about the surgery date.

Theresa Williams said...

Hope it goes the way you want/need, Dawn. Yes, do keep us informed about when and where.