How did we get back here?

About a year ago I noticed a bump on my implant and that my scar tissue was feeling different. My oncologist retired after a heart attack and my care was transferred to a Physician Assistant. At my last two wellness checkups I brought up my concerns which were dismissed.

"Are you losing weight?" No. "Do you have joint pain or bone pain?" No. "Then it's probably just scar tissue or fat deposits". So as long as I'm not losing weight or having pain it's not cancer? "Yes".
All 3 areas grew and 2 were painful, so I found a new doctor and insisted on testing.

My cancer was hormone positive, so I'm on tamoxifen to suppress hormones which is supposed to prevent a recurrence. Fat necrosis was a more logical assessment but ultra sounds and MRIs can't tell the difference between fat necrosis and cancer, so the ever fun biopsies were needed.

It took an hour for the doctor to take 9 samples of the 2 tumors in my armpit as one was really deep and right on a muscle she didn't want to hit. She injected a ton of local anesthetic (which has made my thumb feel like it has carpel tunnel) and used an ultra sound to guide the needle to the right location. It sounded like a gun when she shot and pulled out samples to biopsy. Really weird feeling and experience. My arm kept going numb having to hold it over my head.
Needle biopsies were last Monday, on Wednesday they called me at work to let me know both tumors are cancer. It's been a mental rollercoaster to say the least. I went into today's appointment with surgeon prepared to say good bye to my new boob (look how pretty it is!) but now I may be able to keep it.

For now I'm just trying to get through surgery and the waiting game until we know more. I'm really hoping we can find some answers as to why my cancer came back, but more importantly figure out how we can completely eliminate it this time.

4/23/19

I found a lump the day after Christmas. A few days later I had an ultrasound needle biopsy that left a titanium marker clip in the shape of a cancer ribbon near the lump. After that I had a Stereotactic Core Biopsy that focused on the area with microcalcifications we found in the mammograms. That biopsy left a titanium marker clip in the shape of the letter "M".

I was eating lunch with a co-worker when I got the call. "Is this a good time to talk?" is never followed by good news. "We found cancer".

The good news is the "M" microcalcifications area turned out benign. The bad news is the cancer ribbon tumor area came back positive for cancer (I have a titanium cancer ribbon marking the spot where I will be actually fighting cancer).

I met with my surgeon, Phd MD Grace Tay, and she is great. My step-mom's sister, Terry, actually works in our surgery clinic and knows (and highly recommends) Dr. Tay. Terry came to our appointment with us and she was a tremendous help. Terry can schedule the best team of nurses and anesthesiologist when it's time for my surgery (so awesome to have someone on the inside). I feel like I'm in really good hands.

"Infiltrating ductal carcinoma"
The tumor is just over 1cm and grade 2 (moderately growing cancer cells). We don't know what stage it is, if it's metastasized, or if I need chemo. We won't have those answers until surgery.

I have two choices:
1. lumpectomy plus 5 weeks of daily radiation
2. mastectomy (with or without reconstruction)

The immunohistochemistry came back positive for estrogen and progesterone receptors making me a candidate for tamoxifen. This is really good news because breast cancers in younger women are more likely to be fast-growing, higher grade and hormone receptor-negative, making the cancers more aggressive and more likely to require chemotherapy. With my cancer being estrogen and progesterone receptor-positive and being a moderate grade, my chances of chemotherapy decrease. After surgery I will need to be on medication for 5 years that has menopausal side effects that will most likely lead to early menopause.

I met with my plastic surgeon to discuss reconstruction options. After my Dr. Google research I was really hoping for "muscle-sparing" free TRAM flap reconstruction. It is a single but much more difficult and time-consuming surgery requiring a longer recovery. If done well it is a one and done surgery and should not need more attention over the course of a lifetime. The other reconstruction option is an implant that involves two surgeries that are easier with shorter recoveries but over time are more prone to problems and infections and additional procedures to correct those problems.

Unfortunately, I'm not a candidate for the flap reconstruction so my choices are mastectomy (with implant or no implant) or lumpectomy with radiation. I have really strong reservations about the long term effects of radiation. I'm 41 now. My fear is doing the lumpectomy with radiation only to have cancer come back in 5-10 years and to have limited options then due to the radiation damage.

So on February 4th, I'll be saying good-bye to my right boob as I know it with a mastectomy. I contemplated a double mastectomy, but I'm keeping lefty for now and trying to do genetic testing to see if I'm at risk for ovarian cancer. I thought about no implant and not doing reconstruction, but in the end vanity wins, I kinda like having 2 boobs.

Timeframe:
12/26/15 I found a lump
12/29/15 Dr. confirmation
12/30/15 mammogram, ultrasound, and ultrasound needle biopsy
1/5/15 stereotactic core biopsy
1/7/15 "Is this a good time to talk?" It's cancer.
1/12/15 met with surgeon
1/14/15 met with plastic surgeon
??? When/how/what do I tell my kids?
2/4/15 mastectomy +6 week recovery
4-6 months later reconstruction surgery +6 week recovery

In 8 months I hope to be cancer free and have 2 boobs again. I'll be blogging my progress, inevitable ups and downs, and sharing resources as I find them. Feel free to add your email to follow along on this countdown.

1/17/16