The thing about breast reconstruction after breast cancer is it's a process. Usually, a long process.
All the available methods take time and require stages. With implants, expanders are filled on a regular basis and then removed and replaced with the final product.
Tissue transfer procedures like TRAM and DIEP require an initial surgery to move the fat and skin and then another to make things look good and, if needed, to align the other girl.
Then, of course, building the nipples is another stage, and tattooing color for the areolas is yet another.
The time it takes to progress through these stages varies by individual. I'm realizing that I'm at 16 months and have only completed stage I of my DIEP. There's still a lot left to do, and it will take time.
I'm coming up on the third anniversary of finding my cancer--Thanksgiving night 2006. I don't feel like much has changed. I'm still very busy with cancer fallout--determining and then completing a yearly breast check plan and working to get to the next stage in reconstruction.
Gildna Radner got it right--it really does feel like it's always something or it might be something once they load you on the cancer rollercoaster.
I smile when people say, "It must be so good to be past all the cancer." It doesn't work that way.
I wish it did, but it just doesn't.
Friday, November 13, 2009
Tuesday, November 10, 2009
Is Mastectomy a Better Option if You Have Dense Breasts?
This BBC article says there's an increased risk of breast cancer recurring in dense breasts. The focus here seems to be seeing if women with less-dense breasts might be able to skip radiation after a lumpectomy.
I'd say it also suggests that women with dense breasts should opt for a mastectomy rather than a lumpectomy. It also makes a great case for giving women diagnosed with breast cancer an MRI before surgery to get the clearest picture of what else might be going on in dense breasts before deciding on a lumpectomy or mastectomy.
In my case, an MRI showed two additional areas of concern in another quadrant of the breast, away from the two tumors I found.
After reading this, I know I'm happy I chose mastectomy rather than lumpectomy. I'm also happy I chose to have radiation. Hit it with everything up front so hopefully I'll never have to deal with it again.
To most people who've never had to make the choice, I'm sure a mastectomy seems very drastic, but it gives you more reconstruction options. In my opinion, it's not as horrific as it's held up to be. It ain't no picnic, but it definitely isn't the end of the world.
I'd say it also suggests that women with dense breasts should opt for a mastectomy rather than a lumpectomy. It also makes a great case for giving women diagnosed with breast cancer an MRI before surgery to get the clearest picture of what else might be going on in dense breasts before deciding on a lumpectomy or mastectomy.
In my case, an MRI showed two additional areas of concern in another quadrant of the breast, away from the two tumors I found.
After reading this, I know I'm happy I chose mastectomy rather than lumpectomy. I'm also happy I chose to have radiation. Hit it with everything up front so hopefully I'll never have to deal with it again.
To most people who've never had to make the choice, I'm sure a mastectomy seems very drastic, but it gives you more reconstruction options. In my opinion, it's not as horrific as it's held up to be. It ain't no picnic, but it definitely isn't the end of the world.
Monday, November 9, 2009
Cancer CAN Make You Fat
The author of cancervacation.com wrote a great entry about how breast cancer treatment makes most women gain weight--especially if they get the pretreatment steroids for over a year with Herceptin, as I did.
She's right that it sucks. She's also right that it's an element of treatment that most people don't even know about and one there isn't any support for.
When the medicines make you bald, you can get free wigs from many sources, and most insurance will reimburse a "cranial prothesis." The ACS helps you fake eye hair and cure dry skin with their "Look Good, Feel Better" sessions, complete with a fabulous goodie bag of top-name cosmetics. But you're on your own to remake your wardrobe several times through treatment as your body changes more than a teenager's.
I actually was able to put a good portion of my weight gain to good use in building a new DIEP breast after treatment. But, yeah, I've got extra fat elsewhere that I never encountered before. I hate to shop for clothes because I gravitate to things that I would have looked good in before cancer, and I usually don't like and can't easily identify styles that would look good on me now.
Most people have been kind enough not to mention the weight thing, but I remember when a nurse called to do a preop check for my port removal surgery. She started off by asking, "Have you gained a lot of weight?"
Pardon me; who are you?
She said my file was flagged because I'd porked out--of course she didn't use those words, but that's what I heard. I imagined a red flashing computer screen and a hooting car alarm: We've got a fattie here!
So that bothered me a little. And this back fat perplexes me in a constant kind of way. I think I'm actually going to ask my plastic surgeon to get rid of it and generally spruce up the whole middle section during the second stage of my DIEP. That's if I can get over a crippling fear of more surgery, however minor.
I called to schedule an appointment to start working toward DIEP stage II the other day.
I'll keep you posted.
She's right that it sucks. She's also right that it's an element of treatment that most people don't even know about and one there isn't any support for.
When the medicines make you bald, you can get free wigs from many sources, and most insurance will reimburse a "cranial prothesis." The ACS helps you fake eye hair and cure dry skin with their "Look Good, Feel Better" sessions, complete with a fabulous goodie bag of top-name cosmetics. But you're on your own to remake your wardrobe several times through treatment as your body changes more than a teenager's.
I actually was able to put a good portion of my weight gain to good use in building a new DIEP breast after treatment. But, yeah, I've got extra fat elsewhere that I never encountered before. I hate to shop for clothes because I gravitate to things that I would have looked good in before cancer, and I usually don't like and can't easily identify styles that would look good on me now.
Most people have been kind enough not to mention the weight thing, but I remember when a nurse called to do a preop check for my port removal surgery. She started off by asking, "Have you gained a lot of weight?"
Pardon me; who are you?
She said my file was flagged because I'd porked out--of course she didn't use those words, but that's what I heard. I imagined a red flashing computer screen and a hooting car alarm: We've got a fattie here!
So that bothered me a little. And this back fat perplexes me in a constant kind of way. I think I'm actually going to ask my plastic surgeon to get rid of it and generally spruce up the whole middle section during the second stage of my DIEP. That's if I can get over a crippling fear of more surgery, however minor.
I called to schedule an appointment to start working toward DIEP stage II the other day.
I'll keep you posted.
Saturday, November 7, 2009
Mammograms Have Flaws
I'm loving the articles questionning the universal value of the mammogram. There are cases when the screening is not enough and when it's too much.
Here's a link to the New York Times article that includes these great sections:
"One risk factor is having dense breast tissue, which is a double threat: cancer is more likely and harder to detect, because X-rays do not penetrate this tissue as well as they pass through fat. The only way to find out whether you have dense breasts is with a mammogram, and the radiologist’s report should mention density, Dr. Esserman said. Patients may have to request the full report."
"Younger women, she said, are less likely to have cancer, and they tend to have dense breast tissue, so mammograms are more likely to miss tumors. For them, she said, “it’s radiation without much benefit.” (Dr. Susan Love)
But the article falls short because it doesn't tell women what they should do if the report says they have dense breast tissue.
I'd say if you're following up about something odd that you or your doctor feel, demand a sonogram and a MRI and biopsy if they're not offered--whatever it takes to find out for sure what you're dealing with.
If it's just annual screening, I'd suggest talking to your doctor about MRI as a better screening tool for you.
A couple key takeaways for me: mammograms aren't good at catching the very aggressive cancers, and they can't penetrate young women's dense breast tissue. Young women very often have more aggressive cancers. So, ergo, let's put more effort behind studying this disease as it affects young women.
My favorite paragraph is this one:
"In a certain sense, I have to confess that I’m happy if the public gets offended or infuriated” by the debate, Dr. Formenti said. “I want taxpayers to say: ‘You have no clarity. Study it. Stop telling us you are a good girl if you get a mammogram.’ ”
Yes, let's talk about it, and then let's really do something about it!!
Here's a link to the New York Times article that includes these great sections:
"One risk factor is having dense breast tissue, which is a double threat: cancer is more likely and harder to detect, because X-rays do not penetrate this tissue as well as they pass through fat. The only way to find out whether you have dense breasts is with a mammogram, and the radiologist’s report should mention density, Dr. Esserman said. Patients may have to request the full report."
"Younger women, she said, are less likely to have cancer, and they tend to have dense breast tissue, so mammograms are more likely to miss tumors. For them, she said, “it’s radiation without much benefit.” (Dr. Susan Love)
But the article falls short because it doesn't tell women what they should do if the report says they have dense breast tissue.
I'd say if you're following up about something odd that you or your doctor feel, demand a sonogram and a MRI and biopsy if they're not offered--whatever it takes to find out for sure what you're dealing with.
If it's just annual screening, I'd suggest talking to your doctor about MRI as a better screening tool for you.
A couple key takeaways for me: mammograms aren't good at catching the very aggressive cancers, and they can't penetrate young women's dense breast tissue. Young women very often have more aggressive cancers. So, ergo, let's put more effort behind studying this disease as it affects young women.
My favorite paragraph is this one:
"In a certain sense, I have to confess that I’m happy if the public gets offended or infuriated” by the debate, Dr. Formenti said. “I want taxpayers to say: ‘You have no clarity. Study it. Stop telling us you are a good girl if you get a mammogram.’ ”
Yes, let's talk about it, and then let's really do something about it!!
Friday, November 6, 2009
Got the Plan
As with most things, a good sit-down with my ob/gyn was all I needed to get things sorted out. It would be nice if know-better-than-the-person-who-had-cancer nurses would stay out of the middle, but whatever.
My ob/gyn is taking charge of my yearly breast screenings, and she does agree that my situation requires a mammogram and a MRI.
She showed me the pictures from my last ultrasound that showed no suspicious cysts on the ovaries. With that and knowing I'm not BRAC+, we decided to discontinue every-six month ultrasounds.
We did decide to do a yearly endometrial biopsy to check for endometrial cancer as a result of the tamoxifen. This doesn't happen very often, but there was a very small chance that I should have gotten bc too.
Anyway, it feels like a solid and reasonable program, and I'm happy to know my ob/gyn is behind it 100%.
My ob/gyn is taking charge of my yearly breast screenings, and she does agree that my situation requires a mammogram and a MRI.
She showed me the pictures from my last ultrasound that showed no suspicious cysts on the ovaries. With that and knowing I'm not BRAC+, we decided to discontinue every-six month ultrasounds.
We did decide to do a yearly endometrial biopsy to check for endometrial cancer as a result of the tamoxifen. This doesn't happen very often, but there was a very small chance that I should have gotten bc too.
Anyway, it feels like a solid and reasonable program, and I'm happy to know my ob/gyn is behind it 100%.
Wednesday, November 4, 2009
Maybe Movement Tomorrow
It's been well over two weeks now that I've been trying to get a doctor to endorse an acceptable yearly breast screening program for me and to schedule an MRI as part of it.
I have an appt. with my ob/gyn tomorrow. I scheduled it months ago to go over my pelvic ultrasound scans. Now I guess I'll also be bringing up the breast screening question.
Basically, I want to know who usually schedules and follows up on yearly breast checks. And, if it's the ob/gyn as I suspect, why that can't be the case for me.
If she isn't behind the mammo/MRI combo, I'll just ask her if she'd be okay with just a mammogram after one couldn't find two, 2.5 cm. cancer lumps in her breast.
I'll keep you posted.
I have an appt. with my ob/gyn tomorrow. I scheduled it months ago to go over my pelvic ultrasound scans. Now I guess I'll also be bringing up the breast screening question.
Basically, I want to know who usually schedules and follows up on yearly breast checks. And, if it's the ob/gyn as I suspect, why that can't be the case for me.
If she isn't behind the mammo/MRI combo, I'll just ask her if she'd be okay with just a mammogram after one couldn't find two, 2.5 cm. cancer lumps in her breast.
I'll keep you posted.
Saturday, October 31, 2009
What's Your Happy Ending?
The Assertive Cancer Patient asked this of a group of cancer bloggers, and we're responding with our experiences. I'm honored to be included; feel free to comment with your happy ending if you, too, have experienced cancer.
I've spent the last three days taking temperatures, going to doctor's appointments, picking up medicine, pushing fluids and making comfortable.
I'm perfectly healthy; I'm doing this for my husband and son, who have H1N1 and are really suffering with it. I'm happy to be well enough to run things and, hopefully, speed the family to recovery.
Not so long ago, they and other family members were helping me out as I worked my way through 14 months of treatment for breast cancer, which was aggressive because I'm young.
I'm still in the middle of reconstruction, so surgeries aren't over, and checks to make sure nothing comes back are permanently on my calendar. I can't rule out more treatments, but I'm hoping/praying/assuming we won't have to go there. But if we do, we will.
So, for now, I'm looking at a long, happy future with my husband and son. Even though the house is sick now, I know the clouds will part and we'll move on to the fun stuff again.
It's easy when you're in the middle part of life to let work and raising kids and bills and worries suck too much energy.
My happy ending is to not let this happen to me or my family.
I want to find the balance between planning for a long future and enjoying the hell out of today. I want to learn to live with the fear that I might already know what will kill me without waiting for the other shoe to drop, because maybe it never will.
I don't want to lose too much of my life to worry, and I want to teach my son that, too. This will be tough because I'm a worrier, and I've actually been given something to really worry about.
At the same time, I want to be prepared to act if I have to. For me, that means having a cancer follow-up plan that I can trust. I don't have that yet, but I'm working on it. They don't teach you how to do this in college, but I know enough to know what I need so I will ask until I get it. I want to teach my son that too--to be prepared and look out for yourself.
I will count myself the happiest woman in the world if I get to help my family through their illnesses, share in the countless good times I know we will have and figure out how to skate the space between now and forever, because I want them both.
I've spent the last three days taking temperatures, going to doctor's appointments, picking up medicine, pushing fluids and making comfortable.
I'm perfectly healthy; I'm doing this for my husband and son, who have H1N1 and are really suffering with it. I'm happy to be well enough to run things and, hopefully, speed the family to recovery.
Not so long ago, they and other family members were helping me out as I worked my way through 14 months of treatment for breast cancer, which was aggressive because I'm young.
I'm still in the middle of reconstruction, so surgeries aren't over, and checks to make sure nothing comes back are permanently on my calendar. I can't rule out more treatments, but I'm hoping/praying/assuming we won't have to go there. But if we do, we will.
So, for now, I'm looking at a long, happy future with my husband and son. Even though the house is sick now, I know the clouds will part and we'll move on to the fun stuff again.
It's easy when you're in the middle part of life to let work and raising kids and bills and worries suck too much energy.
My happy ending is to not let this happen to me or my family.
I want to find the balance between planning for a long future and enjoying the hell out of today. I want to learn to live with the fear that I might already know what will kill me without waiting for the other shoe to drop, because maybe it never will.
I don't want to lose too much of my life to worry, and I want to teach my son that, too. This will be tough because I'm a worrier, and I've actually been given something to really worry about.
At the same time, I want to be prepared to act if I have to. For me, that means having a cancer follow-up plan that I can trust. I don't have that yet, but I'm working on it. They don't teach you how to do this in college, but I know enough to know what I need so I will ask until I get it. I want to teach my son that too--to be prepared and look out for yourself.
I will count myself the happiest woman in the world if I get to help my family through their illnesses, share in the countless good times I know we will have and figure out how to skate the space between now and forever, because I want them both.
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