Ever since my diagnosis and the setting of the surgery date for my mastectomy, I have been doing a lot of research into invasive lobular carcinoma, various methods of treatments being used for it and also methods of breast reconstruction. The doctor will be doing a modified radical mastectomy of my left breast, which will include the removal of a number of lymph nodes along with my entire left breast. (See http://www.breastbiopsy.com/bioresults_treatmentoptions2.jsp for further descriptions) A biopsy will be done on the lymph nodes to find out if the cancer has spread to them yet. If it has, this is where my needing radiation will come in on top of the chemo they are already scheduling me for. Because the entire breast is being removed, reconstruction methods are limited to a flap reconstruction (of which there are several types) or an implant.
I have been wrestling with several things as I’ve doing my research. The first being the lymph node removal. I have always been a fairly active person. My hands and arms have always been my means of making an income, either within an office setting as an administrative assistant or repairing/fiddling with computers or bartending. Upon reading what the lymph nodes do and finding out the possible hazards involved with lymph node removal, I want to try to keep the possible hazards to a minimum. Some who have a number of lymph nodes removed develop Lymphedema. Lymphedema is a condition, in which a damaged lymphatic system loses its ability to pump or move lymph fluid, thus resulting in lymph build-up. This causes the arms or legs to swell to several times their normal size and is known to be extremely painful and can be disabling. It also presents the potential for massive infections from even the smallest cuts or inflammation of the skin. To avoid Lymphedema and other problems, there are various precautions. Among them would be limiting the lifting of items and repetitive motions. Because my lively-hood and things I enjoy in life involve lifting, this concerns me. Along with becoming a cancer survivor I also need to continue quality of life. Otherwise, what is the point?
After studying methods of lymph node removal, I felt that doing a Sentinel Node Biopsy might be an option. A Sentinel Node Biopsy is a technique to determine the status of the auxiliary lymph nodes first. The tumor site is injected with a radioisotope and/or blue dye. This is tracked into the sentinel node, which is the first lymph node in the body to come in contact with cancer cells as they leave the primary tumor. The sentinel node is then removed. If there is no breast cancer found in the sentinel node, more than likely no further nodes may need to be removed. If breast cancer is found, then it is generally decided that more lymph nodes will need to be removed. By going with a Sentinel Node Biopsy with minimal node removal, it can often save a woman from the possibility getting Lymphedema.
In order to present my thoughts and questions in an organized way and to give my surgeon the opportunity to answer me at a time that was good for her, I wrote everything in a letter to her. I explained to her my concerns on future usage of my left arm and why I have these concerns. I asked her if a Sentinel Node Biopsy would be a possibility for me. And I asked her expertise on the pros and cons of doing this procedure over the one she is planning on doing.
Her response was absolutely fantastic! She called me and we went over it together. She understands my concerns and she agreed that yes, she can and will do the Sentinel Node method first. She did warn me that if the Sentinel Node shows cancer, then she will most definitely remove more lymph nodes. I totally understand and am hoping for the best here. If more need to be removed, well then, that is the way it needs to be. But if there is a way to keep things to a minimum, I want my best shot at that as well.
Another item that has been concerning me is the reconstruction of a breast to “replace” the one I am losing. The original plan was to insert a saline implant at the time of my mastectomy. Upon plenty of research though, I have started to question my having this done. Implants are a man-made material and carry no guarantees as to longevity or compatibility within a person’s body. Look at what happened with the first “round” of implants that hit the market. In the beginning they were hailed as being relatively safe and a fantastic remedy for enhancing a woman’s breasts or for reconstruction after a mastectomy. As time went on and more statistics were compiled, all kinds of problems started emerging. Some of these problems included illness and death. THAT is a big problem! Looking back, they weren’t so safe after all. Now they have come out with new ones that are supposed to be, once again, “safe”. As before though, there has not been enough time yet to really make that a reliable statement.
There are a few other things that bother me regarding reconstruction and the implant idea.
1) Implants can spring leaks. Doesn’t mean they will, but they can. And they have been known to do so.
2) Cancer can come back and the implant can conceal it.
3) It can interfere with radiation treatments.
4) My body could reject it or build up scar tissue trying to get rid of it .
5) I really highly doubt that any medical insurance is going to cover me from here on out. (Let’s see now, previously I have had a hysterectomy, my appendix removed, my left kidney removed and now I have cancer. Nope, really can’t picture any medical insurance company wanting to take on that risk!) With that in mind, if I were to have an implant and it starts leaking or otherwise has a problem, just what am I going to be able to do about it? How would I pay for it? They can only be removed through another surgical procedure.
6) If it does need to be removed, I am left with sagging wrinkled skin in its place. To me this is no substitute for a breast!
7) What do I do if, once I have it, I don’t like it?
And last but not least,
8) No matter what I do, an implant is not a breast!
Regarding reconstruction, I also have to look at the long-term picture. I need to look at it from a realistic standpoint, rather than from the whirling emotional viewpoint I am caught up in right now. Emotionally, I am devastated that I am losing a breast. The reality? There is absolutely NOTHING that is going to put that breast back. To do a tissue flap reconstruction generally means I have to give skin and muscle from somewhere else on my body and place it on my chest. Is that a breast? No. To remove skin and muscle from somewhere else on my body means the potential for problems somewhere else on my body. I am already getting disfigured at one location, why the heck do I want to add more disfiguration somewhere else? All for the sake of concealing the first disfiguration. When they get around to cloning breasts, that look, act and feel like breasts, well, that may be a different story.
I do have to say, as I write this, this is all making so much sense and might even sound logical. Emotionally, I am a wreck. Tomorrow I have an appointment with the plastic surgeon that is scheduled to do my implant. I want to discuss the various aspects with him regarding my reconstruction options. I need his professional input. Plus, with surgery looming over me at only a little over a week away, I have to make up my mind. I will give him and you my final answer tomorrow.
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