My Breast Cancer Story Part 5: Surgery Decisions and Details

Before I start I have to share that I was so excited when leaving the hospital after finding out I only had one tumour that I barely registered walking right past an inmate (orange jumpsuit, handcuffs, leg shackles, flanked by a couple of correctional officers) on my way out. This memory popped into my brain after I had already written a blog post about that day but seemed noteworthy to include in my records of this whole experience!

Now, in case you missed it: my surgery has been set for Monday December 7th, and I was asked to self-isolate immediately after leaving the surgeon’s office.

Based on my tumour (which is smaller than 2 cm, just so you know as you read on), I was given the choice between lumpectomy (also called breast conserving surgery) plus radiation OR mastectomy (removal of the breast).

My surgeon stressed the fact that in my situation (this could be very different for others based on size, number and location of tumours, just as a few examples) science shows that the outcome is the same for both options.

Just to reinforce this point (as I know from conversations I’ve had that many people, even those in non-breast-cancer-related medical fields, are not necessarily aware of the data), I’m sharing information from four different reputable cancer websites here:

“Lumpectomy followed by radiation is likely to be equally as effective as mastectomy for people with only one site of cancer in the breast and a tumor under 4 centimeters. Clear margins are also a requirement (no cancer cells in the tissue surrounding the tumor).” (Breastcancer.org)

“For women who have the option, lumpectomy (also called breast conserving surgery) plus radiation therapy is as effective as mastectomy for treating early breast cancer.” (Susan G. Komen)

“Regardless of whether you choose to have a lumpectomy or mastectomy, the recurrence rate remains at approximately 10 percent in the treated breast and about 0.5 percent per year in the breast that has not been treated. The risk of getting a different cancer is about 2 percent.” (Hopkins Medicine)

{If you’re confused by the thought of cancer recurring in a breast that’s gone, it’s because of cancer cells in the chest wall.}

“Many studies show that women with early stage breast cancer (stage 1 or stage 2) who have breast-conserving surgery followed by radiation therapy have the same survival rates as women who have a mastectomy.” (Canadian Cancer Society)

To make my own decision i asked questions of my surgeon, my oncology nurse case worker (who has been through this with so many women) and researched on reputable medical sites like the ones named above. I also spoke to several women who have had to make the choice, and learned how they felt about their decision (in one case as much as 26 years later – a family member who had a lumpectomy and has been cancer-free ever since). Many women I heard from or read about were very happy with choosing mastectomy as well, so it really was up to me.

My final choice: lumpectomy with radiation. If the questionable spots on the MRI had been another tumour (or more), I was going to go with mastectomy. Because it’s just one tumour, and the options are equally supported by my surgeon and cancer experts in general, I had to go with my personal preference, which is a huge factor when making a decision like this. That said, just because I think it’s right for me does not mean it’s right for others, and I 100% understand why some women choose a different route.

One of the pros of lumpectomy plus radiation: you keep your breast. My surgeon has made it clear that it will look different, and that I should expect my breasts to appear “more like sisters than twins”…but don’t we all know we’re usually starting from a fraternal twins situation at best anyway? As well, the surgery and recovery are less extensive than mastectomy (though not as much as you might think).

The cons of lumpectomy plus radiation: Well, the radiation for one (though some women have radiation after mastectomies as well). How will I handle it? Will I have side effects? Will it do what it’s supposed to do, which is destroy any cancer cells that might have been left in the breast? During the lumpectomy, my surgeon will remove the tumour, as well as a margin of healthy tissue (he compares it to taking out both the cancerous yolk and the healthy egg white around it). Afterwards, the margins will be tested and if they are very small or contain any cancer cells, a second surgery may be required. There’s also the psychological cost of keeping the breast, which is a deciding factor for many women who want to be able to worry less (and eliminate or minimize stressful follow-ups like mammograms) in the future.

Another note about science: some women feel strongly that they want to remove both breasts (bilateral mastectomy) and my surgeon reinforced what I had read online, which is that there’s no science to support that when it comes to outcomes and survival rates. That doesn’t mean it’s wrong, if a woman feels it is the right choice for her, especially for emotional or psychological reasons. Of course we’ve all heard about women like Angelina Jolie as well, who test positive for an inherited gene mutation (Jolie was tested after her mother died of cancer) and undergo a preventive bilateral mastectomy without even having a cancer diagnosis themselves. According to Susan G. Komen, the average woman has an eight percent chance of developing breast cancer before the age of 70, whereas a woman like Jolie (who carries the BRCA1 gene mutation) has a 50-70 percent chance.

Will I regret my decision? Well, of course if the cancer recurs I will wonder if a mastectomy would have made a difference. However I will follow my treatment plan to the letter, and be diligent about follow-ups for years to come. My doctors now have tons of imaging on file to compare anything new to what’s currently there. If I have a recurrence I will almost certainly proceed with mastectomy then. Would I also want to take the healthy breast? Perhaps I would by that point. But right now, I truly feel this is the best decision for me.

A couple of other surgery deets:

A guide-wire (almost like fishing line) will be inserted before the operation. This is used to help guide the surgeon to the right spot when the tumour can be seen on ultrasound but is not palpable (you can’t feel it from the outside).

Because the sentinel node (the first node that fluid drains to from the breast into the armpit) will also be removed for biopsy (to see if any cancer cells have spread to the lymph nodes), radioactive liquid tracer and blue dye will also be used to help the surgeon locate the right node(s) to remove as he sees which group of lymph nodes the liquids drain to first.

Before I wrap this one up: a special shout-out to an OR nurse I know who has given me some info on how things will be in the operating room to help calm my fears, and even offered to pop in and say hi which is so appreciated. Also a thank you to a couple of different breast cancer survivors who reached out to share their success stories with me – keep ’em coming!