mike always plays this game with me to pass time when we’re traveling together, making a choice between less-than-ideal hypothetical options. would you rather have hair on your eyeballs or on your tongue, no matter if you shaved or cut the hair, it would always grow back? would you rather eat a mayonnaise popsicle or ketchup popsicle? 

i feel like this is my life right now.

last week, i saw my plastic surgeon for post-op monitoring and for him to clear me back to work. he stepped back in shock when he saw the bruises across my left breast. “what happened???!!!” after i provided the highlights, he sat down, deflated. “but we just spent three years getting your breasts even and fitting into clothing!” yep, i got that. we talked about the likely options, and he showed me what 5cm, the span of my atypical cells, really was. it’s pretty significant when talking about a breast that isn’t the DD variety (aka, me). this was all a surprise, but i didn’t have much time to dwell on it, as i prepared to go back to work and hogged the last few hours of medical leave with friends, friday night lights, and the couch.

my first breast surgeon appointment is for april 6. but after some sweet talking and arm twisting with the scheduling gods, i was able to get into another breast surgeon on friday morning; she was to be my eventual second opinion, but i ended up seeing her first. i finally overcame the real inertia i had around getting my medical records from UCSF sent over to her office in another hospital system. and, i was also afraid that the other hospital system would require additional testing of me; they did, a mammogram, but i put my foot down.

i do love this breast surgeon though. she’s a straight shooter but also has compassion in her delivery. here’s what we learned.

the area is big at 5.4cm. it likely won’t ever go away. the hormone therapy i’m on is probably helping prevent it from becoming something more right now, but we’re unsure how long that will last. if we act soon, i may be able to avoid radiation and/or chemo. 

we have three surgical options:
1. do an excision biopsy. this would remove the atypical area, and would not focus on getting clean margins around it. i would have quarterly scans of some sort, which likely would lead to more procedures and biopsies. and, the surgeon thinks i would eventually need more surgeries to remove more atypical areas that emerge, if not a mastectomy.
2. do a lumpectomy. same as above. but with the focus on clean margins, this would leave me with about 1/3-1/2 of a breast in the meantime.
3. do a mastectomy. and with reconstruction involved, it would still be 2 surgeries.

ugh. ugh. ugh.

back in 2012, i was told i didn’t need to have a double mastectomy, that the trend for more young women to have them was most often not medically necessary, as in my case. so, my choice was a single mastectomy. if i had known then what i do now, i would have opted for a double.

the things i most care about–being able to breastfeed and having any sensation left on my chest because a mastectomy severs all nerves–are on the line now. 

my oncologist will not let me go off my hormone medications to get pregnant unless i have a surgery with clean margins. she doesn’t want to take that risk with the atypical cells in my body. and at that point, it’s also not clear if 1/3-1/2 a breast would even produce enough milk to feed a kid. 

my surgeon doesn’t like that idea either, because when pregnant, i’m not eligible for any screening tools–mammograms and MRIs are out because of their impact on unborn babies. so cancer could develop and spread unchecked inside me.

make no mistake, we are in zero rush to have a baby. but these are decisions that cannot be undone. 

neither doctors necessarily want me to have the surgery tomorrow, because i just had major surgery and general anesthesia, and there is a sweet spot between waiting for me to get stronger and healthier AND making sure that the atypical cells don’t progress into cancer. my surgeon commented on the stamina i’ve already expended, having had five surgeries so far. and if i opted for more minor surgeries and surveillance, that requires a different kind of fortitude.

mayonnaise popsicle or ketchup popsicle?

so, i’m planning for the mastectomy right now. i’ll still go to the next surgeon appointment on april 6, but this feels like that is the best option for me as of today. i asked the surgeon if we could wait until july or august. she thought it would be ok but wants to schedule it and figure out what else i’d need to do in the interim.

what else i want to do is:  go on my first work trip tomorrow, go to italy for our five-year anniversary, see family, hang out with friends, get stronger, be able to graduate out of physical therapy for a short window even, enjoy my range of motion and arm mobility, lift stuff, be as normal as possible, and have time to let my decision between a mayonnaise popsicle or a ketchup popsicle sink in.

xom