Thursday, June 16, 2011


Hello. Weeble here. Recently home from 5.5 hours in an 8x8 windowless room. Completely fried. Here's the quick low-down.

We know there's a malignancy in the lower part of the right breast. It's small, and it's in the duct. But there's that other spot they'd been watching in the upper outer part of the same breast - that one didn't show a malignancy, but it does show some funky cell action that needs to be investigated further - there could be a malignancy somewhere close-by. Only way to know is to get in there and get a chunk of tissue. Likely not a huge deal, but need to confirm. None of this is making anyone think of a chemo situation, which is welcome news (jeez, I JUST grew my hair out long again, people!).

So two lumpectomies and then 6 weeks of full-breast radiation are an option. Downtime after a lumpectomy is maybe 2 days - easy-peasy. This would likely be followed up by hormone therapy for some number of years. This would need to be something other than tamoxifen, because I've been there, done that. That leaves a class of drugs for which one must be post-menopausal, which I'm not. So that means either my ovaries would have to be shut down w/another drug, or I'd have to have the ovaries yanked. All this is further complicated by the fact that a side effect of both the hormonal therapy and the ovary-yanking is osteoporosis. I already have osteoporosis from the LAST round of hormonal therapy. Not thrilling. Plus I pretty much felt like junk and had no short-term memory while on tamoxifen.

OR, option B exists, which is a mastectomy. I haven't consulted with a plastic surgeon yet, but my breast surgeon's confident I could do a skin/nipple-sparing mastectomy (and I'd do double, 'cause I never do anything half-way) with immediate reconstruction by way of an implant. No expanders necessary. My recovery time would be 4-6 weeks and there'd be no radiation, no hormonal therapy. Also no more mammos, MRIs, etc. Sounds EZ, but let's keep in mind it's major surgery, there are always risks of complications, and those suckers would be just for show - no feeling in 'em at all. Just squishy bra-fillers that won't fall out at cocktail parties.

I am being re-tested for the BRCA 1 and 2 mutations, too - the testing has evolved over the last 10 years and is much, much better. If I'm BRCA positive, no doubt about it, the breasts go. Huge increase in the risk of another cancer - also ovaries will go too - huge risk of ovarian cancer. But it remains HIGHLY unlikely I've got the mutation - with no family history of any cancer (confirmed again today with a whole 'nother genetic workup), no one sees that coming. We wait about 2 weeks for those results.

What's next? I need to see an oncologist or two (mine and a maybe a second opinion) and have them sell me on the benes of hormonal therapy after lumpectomy. That's what this is going to hinge on, I think. That's years of treatment with a lot of side effects. I'm more leery of that than the double mastectomy, believe it or not. I'll also see at least one plastic surgeon just to confirm we're good to go on the previously irradiated side. I'm also officially calling on all my mast. & double-mast. girls - let me hear your experiences . . . . near-term and far out . . . . let's connect by phone and email over the next few weeks.

I have the luxury of time here, thankfully. If I go the major route, I will wait 'til September. Much easier with L. in school all day and then it doesn't mess with our summer. Lumpectomy can happen any time after our vacation, and then I would wait to start rads in September - again, L. in school makes it all easier.

So there you have it. Soul-searching, here we come. This little Forrest Gump's gotta lace up her walkin' shoes and spend some time thinking about what she wants going forward. It feels good to be officially in the pipeline. I'm still ripped I have to be thinking about this crap on gorgeous June days. But as my surgeon said, this time, no one's really worried about me. My last cancer was so ugly and I was so young that they were all pretty anxious about what the next 5 years would bring. That clearly worked out well. This time, the bugger's a slow-mover. It won't get crazy, it'll continue to plod. So I can read things and interview women and torment my oncologist 'til I get good and ready to pull the trigger on something.

And then I'll get back to whatever the heck it was I was doing when this bomb dropped.




  1. Oh - you are spot on with the double mastectomy comments!! I often joke that I will be the envy of the nursing home, because these little babies will never be saggin' - they'll be perky little reminders for all the days I have left! Not a bad thing in so many respects, but there is certainly no feeling and no Victoria Secret "push 'em up and flaunt 'em" bras in my future. (a small price to pay, however, for ease of mind!).

    The options are often the most confusing part (I thought). When there are not "wrong" or "right" answers it's TOUGH!!! I am MORE THAN willing to talk email/facebook/phone/whatever about my experiences. I have cousins who have done other things than I have done and I'm SURE they would share their experiences as well. Let me know when you're ready to digest more info!!

    Do you have a plastic surgeon? I really loved Dr. Julien Pribaz at the Brigham's. Nice guy (and I did the double with immediate implants - no expanders).

    Glad you are in next phase. Talk to you soon.
    Heidi Tremblay

  2. Since I am not a gal who can help you with your very big decisions in any concrete way, I am just posting to offer love and support... and to say that I am super thankful you will keep some of your wonderful summer plans in place. Hope you got a walk in before the rain this morning! Love you, Sarah.

  3. First, phew on the chemo. Happy, happy, joy, joy on that!

    Gosh the rest is a tough decision. I am not a fan of lumpectomy (my opinion is the bitch has got to go and I never liked the idea of radiation) but also did not do the double as that was too much to wrap my mind around.

    Benefit of the double of course is that they will be even and let me tell you I've got a droopy side and a perky side (we call them the boobie and the boobette) and after two surgeries I know they will never be the same.

    Have you talked to anyone on an aromatase inhibitor? I know you're concerned about osteoporosis but I hear from people online that there are far fewer side effects than the devil tamoxifen.

    I'd like to put a vote in for Dr. Hergreuter at the Brigham but if you do the mastectomy at MGH, don't you have to do the plastics there too? If so, I vote again Yaremchuk, as he's got the personality of a pea. Who's doing your surgery btw?

    Glad you're getting the plan in place.



  4. Oh Sarah...we'll talk. To much info to include in a post. One thing to post...for mastectomy if that is what you choose...the first challenge will be in scheduling as you need both a breast surgeon and a plastic surgeon at the same time. Once you pick what you want to do that will probably inform your choice of plastic surgeon. Hergreuter doesn't do DIEPs so I was referred to his colleague Caterson (love her). There are only 3-4 people who do this procedure in Boston.

    I did things totally out of order but learned that it's usually wise to pick the Plastics person first and then ask which breast surgeon they regularly work with whatever reconstruction you are doing.

    I started the scheduling process in August and had a November surgery date and that was only because Caterson asked one of her less emergency patients to switch with me! Otherwise it would have been December.

    We'll talk more.