Last night I was reminded of Groundhog Day – if the groundhog sees his shadow, then 6-more weeks of chemo – if he doesn’t see his shadow, then we are done with chemo. Today is mostly cloudy (figuratively, not literally, its almost always sunny here).
MRI results are rather encouraging (although I don’t completely understand them) – there is no sign of nodal involvement. The more encouraging line in the results relates to the large tumor on the left breast (L1), which the report says “there is near complete resolution of abnormal enhancement”. The other two tumors, L2 and R1, have shrunk but are still there – as these were slower growing, it isn’t surprising that they are less responsive to the chemo. The general consensus is that I’ve had an excellent response to chemotherapy and that I can proceed to surgery at any time. Chemo is only needed to maintain until surgery – so if they cannot get the surgery scheduled soon enough then additional chemo is needed.
The next new bit of information is relating to the surgery. The breast surgeon recommends a two-stage approach – the first being a lumpectomy, sentinel node biopsy (axillary lymph node dissection only if positive biopsy), and devascularization of the nipple and aerola complex. All the removed parts are then sent to pathology for full analysis. In essence, this is the cancer surgery plus devascularization of the nipple area. The devascularization increases the blood flow to the skin around the nipples, reducing the risk of issues with the reconstruction. It also includes a biopsy of the area under the nipple, which determines whether or not the nipple can can be spared. This is done approximately three weeks after the stop of chemo. I’m waiting to hear on dates for this.
The second surgery is bilateral mastectomy sparing the skin and nipples (only if they are cancer free) with immediate flap reconstruction. This happens about three weeks after the first surgery (this is tentatively set for December 16th but will likely be earlier).
What I like about this approach is that we get the cancer out quickly – so it is gone before it gets a chance to grow again. We will also have pathology before reconstruction. It doesn’t necessarily change the surgeries, but it is a consideration (we will have confirmation that radiation isn’t required). It makes the breast surgeon’s part of the second surgery a little easier, but that isn’t the big part of the second surgery. The bigger part is the reconstruction – so the second surgery is still a long surgery (8-10 hours).
After the second surgery I start anti-hormone therapy (tamoxifen) for 10-years.
There is also a third surgery that takes place no sooner than 3-months after the reconstruction. This is the “revision” surgery. Once everything has healed from the cancer surgery and primary reconstruction, the plastic surgeon goes back in and cleans up any scar tissue and lyposuctions any extraneous fat pockets.
So where does this leave me? After all the surgery discussions today, my oncologist still wants me to do one more chemo treatment. I wasn’t willing to do it today (I have mouths sores and I want to give them a little more time to heal). So I have chemo scheduled for Thursday. Depending on when the first surgery date is, this will likely be my last chemo.