Lumpectomy, Mastectomy, OMG

November 2nd – My first meeting with my surgeon.  Brian and my mom go with me.   Everyone in the waiting room is 25-35 years older than me.  

We nickname the surgeon VLT.   VLT is calm, pretty, stylish, with a huge diamond on her finger.  She is surprised to see my mom and Brian. She wants to do an ultrasound; is it OK that they’re in the room?

I’m not shy, and both of them have seen my breasts before.

I put on a paper robe, leaving the openings in front.

VLT performs a manual exam and an ultrasound, measures the tumor with a ruler, draws its outline on my breast with a purple marker, and takes photographs of my breasts.  Then we go into a meeting room to talk.

She suspects invasive cancer is present in addition to the ductal carcinoma in situ (DCIS). DCIS is not usually accompanied by such a large mass (the tumor is 4cm across).

VLT switches between clinical terms and lay terms to make sure all of us are following.    Her manner is calm and measured, laying out the possible courses this could take in a balanced way. 

Stage describes the spread of the cancer – how big the tumor is and how far it has spread.  DCIS is Stage 0.  “In situ” cancer is non-invasive and unable to spread outside the site – in this case, the milk ducts.  

Grade describes how the cells are behaving.  These cells are grade 3, the most disorganized and aggressive type of DCIS.  

A biopsy is only one tiny point – the point where the needle went in and took out a sample of tissue.  A pathologist can see the cells that came out of that one sample point, but they don’t know what type of cells are present in the rest of the breast.  They won’t know for certain until after surgery, when they analyze everything removed in surgery very closely, and do a final pathology report.  I could opt to get another biopsy, but that would mean more waiting, and it would still only give a clear picture of that one tiny biopsy point – it wouldn’t rule out the presence of invasive cancer elsewhere in the breast.  We decide it’s not worth it.

It’s clear I will need surgery – lumpectomy or mastectomy.  Whether or not I will need radiation or chemo depends on what they find after surgery. 

VLT brings up reconstruction.  I may be a candidate for nipple and skin sparing, so they could reconstruct my breast with an implant underneath my own breast skin.  If I did a nipple-sparing lumpectomy, I would still be able to breastfeed from that breast.

I feel very, very calm during our visit and notice small details.  VLT’s scribbled drawing of breasts and incision points.  The shoes she is wearing.  The temperature of the room.   Afterwards the three of us go out for Korean food.  The world seems unreal, and hyper-real at the same time. 


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