My Name is Not Cancer Girl

This post is going to be a little disjointed because I’m going to dump some serious graphic content about my reconstruction a little later. I’ll give you a warning to leave if you have no interest in finding out the details of a TRAM reconstruction from the patient’s perspective, but it is pertinent to the whole of the news we got Monday from Dr. A. So, deal with it if you can, and if you can’t then you’ll at least know the basics of what is going on here.

I had my second chemo yesterday, and like all chemo appointments, I met with Dr. A before my treatment. This isn’t true of the Herceptin-only weeks, those are nurse-only visits. That’s a large part of why I can be in and out in under an hour.

This was my first visit with Dr. A since we got the pathology last week from Dr. S. that the second biopsy was more IDC. The news was pretty encouraging, the cancer she found was more of the same, same HER2+, ER+/PR+ status, and it was exactly what she would expect the lump under my armpit to look like after a round of chemo and two rounds of Herceptin. She was not discouraged at all by the pathology. If anything, after talking with Dr. S., she was relieved to see the full pathology because Dr. S. had her believing that it was a whole different beast.

Chemo continues for another 2 rounds, and sometime in late-December or early-January I’ll have another PET scan to make sure that the disease has dissolved mostly if not completely. I will definitely do 6 rounds, and if I can remain on schedule, that will put my last chemo treatment on February 1st. I also found out that my Herceptin treatments will continue every 3 weeks after the 2 immediately following round 6, so I wont be getting infusions every week for a year. That was happy news.

The part that took the wind out of my sails was that we are going to have to reverse my reconstruction. Remember those beautiful foobs I was telling you about way back when? Sometime in the March/April timeframe, they are going to come off and I am going to have to go with another shiny new set of ‘tas.

Just so we’re completely clear, I am not a doctor. I have never studied medicine, and I am only giving you the information I have from my experience as a patient. I am not a dumb ass and I do pick things up pretty quickly, but anything I’ve learned has been from conversation with my surgeons and other TRAM patients, not medical school.

***GRAPHIC STUFF STARTING NOW*** Leave here if you have a weak stomach or if you are eating your morning oatmeal.

Most TRAMS are completed using a skin-sparing technique. This means that the surgeon opens the breast by cutting around the nipple, down from the nipple to 6 ‘o-clock and then over from 5:00 to 7:00. It’s called an anchor scar for those in the know about breast reductions/lifts. During the mastectomy portion of the surgery, the skin is pulled back, the breast tissue is scraped out as much as possible and removed. Also the nipple is removed and discarded since there is no way to completely remove the breast tissue from the nipple.

After the doctor removes as much tissue as possible, the reconstruction surgeon starts to refill the chest cavity. In my case, we did an abdominal TRAM. Dr. B., my plastic surgeon, made an incision similar to a tummy tuck, from hip to hip. He removed a bunch of fat and some muscle and shaped it into two pieces, removing the external skin from the transfer, except for a small round piece which filled in the part where the nipple had been. Using amazing skill, Dr. B. attaches the blood vessels from the abdominal muscles to the pectoral chest muscles so that the skin and fat tissue has blood flow and doesn’t die. He does some additional shaping, and then pulls the breast skin back around, sutures up the whole thing and then we wait to make sure that the fat transfer takes. It’s a nervous 48 hours making sure that the “flap doesn’t fail” while we make sure that the blood vessels are doing their job and pumping blood to the tissue transfer.

The reason that I am going to have to have my TRAM removed is because we, that is my doctors, believe that the skin-sparing technique is why I’m having these recurrences. My original pathology showed clean margins, meaning that there didn’t appear to be any cancer having crossed the barrier to the skin, but, this doesn’t seem to be the case. Since there is no way to completely remove the breast tissue from the skin, to remove the chance for recurrence we have to remove the original breast skin, and the underlying reconstructed tissue that has been exposed to this skin.

I’m not fully up-to-speed on what the new procedure will be. I do know that it means that I will have to have a skin graft from somewhere else on my body, probably my back, and we will start over with an expander to slowly stretch the skin so that an implant will fit. I will probably go with a saline implant since I can’t seem to get the fear of a silicone leak out of my head. Please, no hate mail about the safety of silicone. I know that they are extremely safe, but I just don’t want to have any more things to worry about after a second double mastectomy before the time I’m 43.

But, really, how many women get to say that they’ve had 3 sets of tits in their life? Pamela Anderson and me? I do know that there are others out there. Dr. A said that she sees about 1 patient every 3 years that has this issue. I wish each of them such a great team of doctors working with them and for their health.

But, again, I have to remind myself how lucky I am. This could have been so much worse. This could have been found when there were no options. I still have every tool available in the cancer fighting arsenal. Please, don’t take my optimism as naivete. I’m not stupid or uninformed, I do realize that my body isn’t giving up the disease easily, but I will fight dirtier and harder. C and my boys deserve that from me.