Sunday, 27 October 2013

Choices, choices

The first stage of my treatment was to be surgery to get rid of the cancer.  To begin with we talked about lumpectomy as a surgical option.  This sat ok with me and Will.  My lump was not huge, although 35mm sounded pretty flippin large to me seeing as I’d only just discovered it!  But as the doctor very tactfully said, my boobs aren’t that big (34B) and so removing a lump of that size may not give an aesthetically pleasing result.  We were told to go away and think about it. 

We did think about it, talked about it and googled photos of lumpectomy results.  Will carried photos of misshapen boobs on his phone to show to the doctors, not the stuff of playboy magazines that’s for sure!  Although the images we saw did not look great, we both thought that conservative was the way to go.   

The way we saw it, getting rid of the cancer was the most important thing.  What my boob would look like didn't seem that important at this stage.  The doctor said that some women would do anything to avoid a mastectomy whereas others might insist on a double mastectomy just to get rid of the cancer and ensure it didn't ever come back. It was really a personal choice.  I didn't have any strong feelings either way so it seemed sensible to us to go the least invasive route and like the doctor said, I could always change my mind later and go for a mastectomy if I wasn’t happy.
A week later we were back with the lovely Mr Hamed and the breast cancer nurse to talk things through again.  He had another feel of the lump (my right boob was certainly becoming public property and not my own anymore!) and a measure of the lump with some pincery things and said 'How would you feel if I told you I think you should have a mastectomy?'  What I really wanted was for someone just to tell me what to do.  I didn’t want to have to make these decisions.  How could I know how I would feel, what it would look like, what it would feel like?  I told him that if that's what he thought was best, then I would go for it. 

So suddenly, my whole boob was going to be chopped off.  Ok.  That’s fine I guess.  Whatever needs to be done.  Its not like it’s a leg or an arm or something. 
But that wasn't the decisions over.  Far from it.  What sort of reconstruction would I like?  Did I even want a reconstruction?  Should I have mastectomy and delay the reconstruction until the rest of my treatment was over (chemo and radiotherapy).

Oh man, this was getting complicated.  The surgeon patiently went through all the different options with us.  He explained things clearly but it was still difficult to take it all in.  If I went the reconstruction route, he said that doing it at the same time as the mastectomy was preferable as it gave a better result.  I could opt for an implant (silicone) or tissue (fat harvested from elsewhere on my body).

Using an implant is a far less complicated surgery but is not strongly advised if radiotherapy is required (in my case it was) as it can react to the radiation and become hard, painful or deformed.  Tissue reconstruction gives a more natural result which ages with the body unlike an implant.  It also does not react so badly to radiotherapy.  But the big question was, did I have enough excess fat on my body to provide an adequate new boob?  The doctor was dubious. 

I was referred to a plastic surgeon who I was told would have a good old grope of my fat bits and decide if there was anything usable.  Bloody hell, what if I went home and ate all the pies, would that help?  Needless to say I had offers coming out of my ears of donor fat from friends and family.  Sadly, it had to be my fat.  I was cursing my ‘skinny genes’ for once in my life.

We met with the plastic surgeon a week later, actually a whole team of plastic surgeons and nurses.  They all stood around as I was asked to remove my gown and stand naked so that they could appraise my blubber.  I was prodded and poked like a piece of meat.  My right bum cheek was deemed to have enough quality fat to be used as a donor.  Hurrah!  This was good news, I think. 

But as Will and I  left the hospital, we realised we had done a complete 180 on this.  Suddenly I was going from a conservative lumpectomy to a full on tissue reconstruction involving 6-8 hours surgery, including micro-surgery to give the donor tissue a blood supply.  I would have two or possibly three surgical wounds to contend with (the lymph nodes under my right armpit also needed removing due to the cancer having spread to at least one node).  For some having another large scar (in my case, along the top of my bum) would be unthinkable but I wasn't really bothered about that side of things.  Had we made our decision?
We went away on holiday and were given that time to think it over further.  I think I already knew what I wanted to do, but it was nice not to feel rushed.  I don’t really know how I came to the decision in the end.  The tissue reconstruction felt like the right option, although none of it really felt right, obviously.  My bum was suddenly going to become my boob.  If that’s not topsy turvy and a complete spin out, then I don’t know what is!

You might wonder if you can really enjoy a holiday when you’ve just been given a cancer diagnosis.  Well I can tell you, I did enjoy it, mostly.  It was a great distraction.  I had to wait another month for my surgery date anyway so better to be on holiday than at home trying to be normal.  Will and I rode our motorbikes down through France, saw family and friends and had a little pootle through the Alps.  It was just the right mix of activity and relaxed-ness.  The calm before the storm. 

Beautiful vistas.....

and plenty of wine!

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