Brutal Reality

I had never seen pictures of women post radiation, lumpectomies or mastectomies until yesterday. I'm speechless. The images brought an entirely new depth of the brutal reality to the theoretical, procedural context that I've been living in. In the waiting room of the plastic surgeons office on Monday, I sat anxiously, listening to tedious elevator muzak with an instrumental cover of "Do you Really Want to Hurt Me" amongst others I've since blocked out being piped into the waiting room while I looked at the coffee table book there "Reconstructing Aphrodite" http://www.reconstructingaphrodite.com/ However, brave, bold and courageous these women are having gone through breast cancer and survived only with scars and disfiguration's on their bodies...all I could think about was my potentially pending new nick name "Franken boobs" :-( And just as that thought occurred, a young, tall, blond, blue-eyed woman in high, high heals, a tweed, khaki colored pencil skirt and matching suit coat walked into the waiting room extending her hand out to me saying "Hi Ally, I'm Karen Horton." Magically, her bright, shining smile and unexpected introduction made me have a momentary lapse in memory. She greeted Spike and we followed her back to her office. In the next several moments, I experienced the upgrade in medicine. In her styled out, luxurious office, Spike and I were seated in plush, designer, suede chairs...not a sterile medical examination room. We talked about the pathology reports and what I know and understand about my options. She was very thorough in both her interview and explanations, insisting that I do my homework and explore all of my options regardless of my preferences. Then, she asked me my bra size and to undress entirely, and pointed to a very plush, full length robe hanging on the back of her door. Yes folks, apparently seeing a plastic surgeon is indeed the upgrade from coach to first class in medicine.

Now, what's that in my hand, you are wondering? Well, that my friends is a silicone "c" cup implant. I told both Dr. Lewis and Dr. Horton that I was not interested in implants, and was leaning towards lumpectomies with radiation and hormone replacement therapy at this point. But both insisted that I be educated about all of my choices before I make my final decision. And so, I held the implant, and played with it a bit, just out of curiosity, then I passed it along to Spike as we listed to Dr. Horton explain both the pro's and the cons of getting implants...

Pros: 1. The implant surgery could happen at the same time as the bi-lateral mastectomy, only takes a few minutes and is a quick, easy recovery (1-2 weeks). 2. The implants are fully adjustable (meaning they can be inflated or deflated) as I heal and the swelling goes down in order to get the perfect fit for me. Also I have the option of being as big, or small as I want to be with no problem. "Big or small, Dr. Horton makes them all!"

Cons:

1. With implants, there's no more nerve sensation. So, all show and no feeling.

2. Implants require daily maintenance (massages), which would be great if you had feeling, but without that, it just means yet another obligatory self-maintenance chore to take care of. 3. Implants also need to be surgically removed and replaced every 10 years. So, I'd be signing up for a surgery at 48, 58, 68...

Conclusion on implants...NO THANKS!!!

Now that I was in the plush robe, Dr. Horton wanted to do a full body examination to see if I could be considered a candidate for the D.I.E.P. flap (deep inferior epigastric perforator) surgery, where they take the tummy fat, do a tummy tuck, and create breasts out of the tummy fat, or a T.U.G. flap (transverse upper gracielis) surgery, where they take the fat from the inside of the upper thighs, do a tuck, and create breasts out of the inner thigh fat, reattaching the nerves and vascular system in the nipples and breast. Standing naked in Dr. Horton's office while she examined me in front of Spike and took pictures was a very surreal and awkward experience. That is Dr. Horton taking pictures of me (rt.), but that is (obviously) not me standing naked in her office (lft.). I have to draw the line somewhere people (Sorry, Pam). It's been challenging enough to muster up the courage to show pictures of my soon to be gone breasts on the Internet! That's me posing Easter morning for Spike in PV (the shadow on the side of my right breast is the bruise from the batched biopsy, not a shadow).

The bad news is that I don't qualify for the D.I.E.P. flap surgery. I don't have enough tummy fat anymore; A great problem to have! ;-) The good news is that I do qualify for the T.U.G. flap surgery, which means that there is enough fat on the insides of my thighs to reconstruct my breasts, though they may be a bit smaller. I quickly asked if she could perhaps take a little from the outer thigh or my butt to supplement. She smiled and said, not for this, unfortunately that's another surgery altogether. The fat tissue in the outer thighs and butt tends to be denser and more fibrous, not able to mimic the soft, squishy, supple breast tissue. And so, she educated us on the pro's and con's of the T.U.G. flap.

Cons:

1. The surgery is very complicated, requiring a 8-10 hour operation with a well planned, timed and executed team of 5 surgeons, and 5 specialists to do everything from biopsy of the tumor and lymph nodes to see if the cancer has spread to removal of my breasts and lymph nodes and micro-scopicly disconnecting and reconnecting veins, arteries and nerves to reconstructing my

breasts, all the while monitoring anesthesia, vital signs, blood, etc. Only a handful of surgeons in the world do this surgery, Dr. Horton has the most experience 2nd to the guy who invented the procedure in Europe.

2. The surgery requires 1-2 nights in ICU afterwards, followed by 5-6 nights in the hospital with 4 tubes (draining the breast and thigh incisions - Krista, you better clear your schedule), and the 6-8 weeks of recovery time.

Pros: 1. I will have breasts reconstructed from my own tissue salvaging my breast skin, nipples and nerves, it will grow strong and healthy with me as me. 2. I will not have to go through a series of surgeries over the years to maintain. 3. I will have hours of uninterrupted time to focus on my friends/ family and finishing my book.

Conclusion on the T.U.G. flap reconstruction...YES, PLEASE!!!

Now, just so you know, and here's where it all gets difficult...Right after I met with the fabulous plastic surgeon...I spoke to Barbara Brenner, the executive director of Breast Cancer Action and leading researcher/legal advocate in the U.S.

My questions to Barabra were:

1. What is the chance of breast cancer recurrence if I should go with lumpectomies?

2. What are the risks/side effects associated with radiation treatment if I go with lumpectomies?

Barbara asked me to read my biopsy pathology reports to her. Then she said "Ally, what I think you're asking me is to tell you how it is directly and honestly so you can make a good decision, so I'm just going to tell you. You have cancer, there's no turning back, it's more than likely in your blood. Everyone of us has the cancer gene, our environmental influences by far out number our genetic or hereditary influences. You are the 1 of 4 women* (*2007 statistic - now more likely 1 in 3) who got breast cancer, every 1.9 min. *(*2007 statistic - now more likely 1.6) another woman is diagnosed with breast cancer. Based on your pathology report, you have a 75% chance of survival regardless of what procedure you go with. It is 90% likely that you will have a recurrence of breast cancer if you go with lumpectomies and radiation treatment, and will end up having to have a bi-lateral mastectomy anyways. There is a 100% chance that radiation will permanently scar and disfigure your breast tissue, and puts you at risk for bone, skin and blood cancers. Breast reconstruction is a personal thing. You must decide what's best for you."

As I listened and recalled the images of women who had lumpectomies, mastectomies and reconstruction; the images I've seen of women and children, bald , pale and withering from chemotherapy treatment...I broke into a million pieces, sobbing deeply at the realization that this was not just a surgery with a few little scars, and some pills for after care. The price of being a survivor is costly, and I was going to have to fight for my life. Everything after that conversation has been a blur...I've written and re-written this blog post 4 different times since I started it Monday night. Spike and I have cried and held each other every morning, noon and night, several times a day, alone and together. And...I don't know what else to say...I am without words...