appointment updates

A very busy week to update everyone on...

Last Friday (Jan 6th) I had an appointment with my local ob/gyn - Dr. Dwyer, because of some discomfort I started having. Three years ago I had a partial hysterectomy but he left both of my ovaries. Dr. Dwyer felt I needed to have surgery to have my ovaries removed for several reasons. First, my breast cancer diagnosis ~ breast cancer and ovarian cancer are very closely related and in circumstances where there is a genetic link there is an even greater link. Off topic for a second, my BRCA 1 and BRCA 2 (currently the only two genes that can be tested for genetic links to breast and ovarian cancer) came back inconclusive. There was a mutation on one of the genes that has only been seen about two other times so there isn't enough information to determine the relevance in my case. The genetics team that I worked with strongly felt that with my family history and the type of cancer that I had that there was a genetic component. Secondly, Dr. Dwyer thought it best to have surgery because the only solution to the pain (assuming there was nothing bad causing the pain) would have been to put me on birth control pills and any time you have breast cancer you aren't allowed to take any type of estrogen. Everything he told me up to this point I had pretty much already prepared myself for. When I was first diagnosed I decided to do everything possible to reduce the chance of a recurrence - which included prophylactic mastectomy on the right side, and removing my ovaries, I just hadn't planned on doing it this soon! The part of our conversation that day that I wasn't expecting was that he didn't want to do the surgery... WHAT?!?! Not what I was hoping to hear! His reasoning however made perfect sense ~ because they would have to approach this surgery as the ovaries were being removed because of cancer he felt the surgery should be done by a specialist at UNC. At this point we still don't know why I am having pain.

So Wednesday and Thursday were both spent at the cancer hospital at UNC. The first day I had my first appointment with the plastic surgeon. Lots of information to take in that day. The two main possibilities for reconstruction are implants or tissue flaps. Tissue flaps are when they take tissue and muscle from another part of your body, usually the abdomen, thighs or buttocks, and make a new breast. The possible problem for me to have any surgery is the fact that my skin on the left has been radiated. Even though from the outside the skin looks pretty normal now there are microscopic changes under the skin that make any surgery more difficult. While thinking over Christmas I had pretty much decided that I really didn't want to do the tissue flap unless there was no other option. Well, after seeing the surgeon I'm glad that is the way I was leaning because I'm not a good candidate for that type of surgery. Most people who have the tissue flap surgery have the tissue and muscle removed from one or possibly two areas but I don't have enough in even two places so it would require probably taking from at least three different areas. Thank goodness Dr. Lee didn't feel that was a great option! So the only other way for me to have reconstruction would be to have implants placed. This is a little more complicated than usual as well. The radiated skin on the left makes it difficult to do this surgery without using a tissue flap from your back to give you more skin and muscle to hold the implant. Notice I said more difficult but not impossible. Dr. Lee is willing to try this surgery without a tissue flap from the back if I choose to do so. There is a high risk that it may not work, which would put us back to square one. So for the left side I have to decide whether I want to give expanding the tissue for an implant and not taking the flap from the back or if I want to just go ahead and do the surgery with the flap from the back. There are some things that weigh with either option... doing the flap from the back can cause you to loose some of the use of the arm on that side permanently. Whether you include the tissue flap in this surgery can also mean the difference in symmetry and size of your final result. The surgeon would like to give my left side about six months from when I finished radiation before we do the surgery so I have some time to decide about the tissue flap. What we do know for sure is the first surgery will include my general oncology surgeon coming in to do the mastectomy on the right, and then the plastic surgeon will be placing tissue expanders on both sides (the left either with or without the tissue flap from the back).  After you are healed, the expanders will have to be "filled" about every three weeks through a port in the expander under your skin. This process takes about three months. At the end of the fill process there is a final surgery to remove the expanders and to place the final implants. There are risks involved with having implants placed but as I'm not comfortable with not having any type of reconstruction for right now this is my only option. Having no problems at all would be ideal, but what I am hoping is that this option will last until they come up with another option later down the road.



My appointment Thursday was with the specialist that Dr. Dwyer referred me to ~ Dr. Clark-Pearson. Dr. CP concurred with Dr. Dwyer in that he felt we needed to go ahead and do surgery to remove the ovaries. He was concerned however that I was having pain. They sent me over to have an ultrasound done and we are still waiting on the results of that. As soon as I hear from them I will keep everyone posted. The surgery date will depend on what the ultrasound shows. I'm hoping for March as this would maximise my insurance benefits, but am prepared for it to be much sooner if the ultrasound results show something that can't wait. Dr. CP is a little concerned about the after math of a surgery like this for a woman my age. This surgery will put me into pre-menopause. Normally not too big of a deal they would just prescribe hormones and that would be the end of it, but for me the hormone replacement won't be an option because of my history of breast cancer. This is something that he, my medical oncologist and I will need to look at more closely to see if there is an alternative that may work for me and my situation. So for now we are waiting on results.

I know this post is full of information. This is all stuff that has been going on for a few weeks, but I wanted to wait to post it until I could answer as many questions that I had as possible. Please keep the results of the ultrasound in your prayers, as well as me and the decisions that I will be faced with in the next few months. Off to enjoy my weekend! Going to try yoga for the first time! Happy weekend everyone!