You Won't Find This Camisole at Victoria's Secret

Well, the surgery date is fast approaching - a week from Wednesday. It doesn't seem to be bothering me that I have only nine more days to spend with my breasts. I am sure if that means I am in acceptance mode or in total denial...

Last week, a woman from Sentara Home Health Care called to discuss the surgical camisoles she had ordered for me and that would be delivered to my hospital room on the day of surgery. She asked if I would be having reconstruction. If not, the camisoles could be worn for four to six weeks until I could be fitted for a prosthesis (or two as the case may be), and she would be available to help me with that process, if necessary. The camisoles even come with "puffs" that can give my figure a little bit of shape in the meantime. She was very kind, but at that moment, the reality started to sink in, and I felt tears begin to well up. Then I reminded myself that the surgery, while making me breast-free would also make me cancer-free, and they were, afterall, just breasts. The moment passed.

Dr. P, my faithful and beloved oncologist called to say she had been in touch with Dr. B, the "boob dude" or as he may prefer to be recognized, the plastic surgeon. Dr. B is not a proponent of what I have dubbed the "saddlebag" flap surgery (the medically correct name is the Ruben flap) and told Dr. P it leaves patients with a lot of pain. So Dr. P said we are back to the following two options:

Option 1: I can have tissue expanders placed at the time of surgery on both the right and left sides. It would take about three months for the tissue to expand to the point where implants can be inserted. This would delay the radiation treatment by several months. Then I would run the risk of damage to the right implant when it is radiated. Dr. B says in his experience, the damage is infrequent and isn't anything he couldn't fix. Both Dr. P and Dr. G (the radiation doctor) do not feel it is a problem to delay radiation. (When I asked Dr. G she said it wouldn't impact the efficacy of the radiation either.) It does make monitoring of the chest wall more difficult, but Dr. P said, when asked, my risk of local recurrence is in the single digits. Nonetheless, Dr. H, my surgeon was quite opposed to this option.

Option 2: I can wait six months until after surgery and then have an implant on the left side. (The left side is not undergoing radiation; therefore, there will be no damage to the tissue and it can be stretched at that time.) An implant will no longer be possible on the right side as the skin will have been radiated and will no longer be e-x-p-a-n-d-a-b-l-e. Dr. B can then do flap surgery using the lattisimus muscle from my back shoulder. This will result in significantly reduced strength on the right side and a large scar down my back.

Now if you are wondering, as I was, why my options are so limited, here's the deal: Most women have either a lumpectomy with radiation and therefore, don't need reconstruction, or they have a mastectomy without radiation so they don't have to worry about radiation damaging the implant (or if they do have a mastectomy with radiation, most women have enough abdominal tissue to do flap surgery.) Because I had lymph node involvement and because of my young age (yes, 41 is still young - especially when dealing with breast cancer), my doctors have advocated the most aggressive treatment plan possible, and I have chosen to follow their recommendations. Back to THE DECISION ( or at least the latest decision).

I have used all techniques at my disposal to make a decision:

I have applied rational thought and extensively considered the pros and cons of each option, listing them in alphabetically order on an 81/2 x 11 sheet of paper.
I have applied emotional thought about how it will feel to be without breasts and to have scars where my breasts once reigned, poised ever so slightly over the rest of terrain.
I have prayed for the solution and listened for a quiet voice to tell me what to do.
I have thrown the question out to the universe and waited for the answer to appear on a billboard or tatooed on my forehead.
I have posed the question to my subconscious before going to bed, hoping to awaken with the response immediately apparent to my conscious mind.

To no avail... nine days out, and I still don't know what to do which I think means that I do know what to do. I am going to wait until after surgery and see how I am. That will pretty much eliminate option 1, but it doesn't make reconstruction in the future an impossibility. Okay, I feel so much better now that I have written that down. Barring any tattooes mysteriously appearing on my forehead, THE DECISION is made. Can you hear the deep sigh of relief I just released?

Now, back to the conversation with Dr. P. When she told me my risk of local recurrence was in the single digits, I asked her what my risk of distant recurrence was. After I asked, I wondered if I could take the question back, and as she took her time responding, I almost told her I didn't want to hear the number. Afterall, I am not a statistic, I am unique, and I already know that I will not have breast cancer again.

Nonetheless, I was pleased to hear the answer she gave after she gazed into her crystal ball (punched some data into a computer program): With a mastectomy only, 40 out of 100 women with my situation (size, lymph node involvement, grade, etc.) will have a recurrence. Once combined with chemo and hormonal treatment, however, only ten out of those 40 will have a recurrence. I felt very comforted by the statistics even while recognizing my own individuality and my unique DNA.

Now that I have made my decision about holding off on reconstruction, and I think about what else to write before I conclude this posting, I can't help but wonder if the universe did speak to me earlier today, or if my prayers were answered through a quiet voice...

Clay awoke last night complaining about his legs, arms, neck, and abdomen hurting. He was running a slight temperature this morning, so I took him to his pediatrician. It turns out the one part of his body that wasn't hurting was the one creating his illness. He has strep throat.

I hadn't seen this Dr. G since my diagnosis, but Bo had told her about me the last time he was there with Lance. At that time she shared with Bo that she had had a double mastectomy. She asked me how I was doing and I brought her up to speed. She had her surgery five years ago and never had reconstruction. She spoke openly her experience, and I appreciated her honesty, candor and genuine concern. She mentioned that the only time the prosthesis is really uncomfortable is in the summer when the weather gets hot and sticky, and then the prosthesis gets hot and sticky. However, there is now a new and improved version that has a fabric lining, and this helps. She recommended Nordstrom's for all my post-mastectomy needs. Most importantly, she shared that for her, breasts aren't her identity, and that her attendance at future graduations, weddings, etc. is what is really important.

And so as I reflect back on this event, I realize I received a subtle sign, this message from a very successful women who is so self-assured, yet comforting, confident, yet calm - our hearts, minds, and souls embody the true strength and spirit of womanhood, not our breasts. Maybe this "sign" isn't as dramatic and blatant as a billboard broadcasting "Don't go with option 1," but it is far more powerful.