Recap of where we stand

I have gotten some questions about exactly where we stand and what the plans are so I figured I would provide an update on the blog.   I am providing a fair amount of info which might be a little too much information for some people.  Consider yourself warned!

I have estrogen and progesterone positive breast cancer in my right breast.    There are at least 3 separate cancerous spots and potentially a fourth.  We do not know the size of any of them (or at least no one has told us).   It does not appear that the cancer has metasticized elsewhere in my body.   The first place the cancer would go is into the lymph node closest to the tumors and per the MRI it does not appear it has spread to there but we will not know for certain until after my surgery.     The MRI did show some nodules in my left breast which I will have looked at on Monday morning via ultrasound.  I am not sure if they will have to be biopsied at this point.

On Friday, March 4, I will have surgery at Morristown Memorial Hospital.  The surgery will either be a single or double mastectomy with the first step of reconstruction at the same time.  (The single versus double is a decision for me to make at this point, as the left side is not technically "required" from a medical perspective.)  There will be 2 surgeons in the room - my breast surgeon (Dr. LG) and my plastic surgeon (Dr. BG).   The breast surgeon will remove all my breast tissue (including one or both nipples) and will do a sentinel node biopsy on one or both sides where they test the lymph node closest to the tumors for signs of cancer.   The test is done in the operating room.   If that node comes back negative, they will not remove any more nodes.  If it comes back positive, they will remove more.   The goal is to remove as few lymph nodes as possible to avoid potential lymphadema. 

Once Dr. LG is done, the plastic surgeon moves in to reconstruct my breasts.    Initially, he will insert tissue expanders which will be expanded over the coming weeks to slowly stretch my skin in order to be able to replace the expanders with implants in the size I want (my current size).   The expanders are needed because I will lose some skin during the mastectomy (I assume mostly because of the nipple removal).    The expanders (which feel like "softballs glued to your chest" according to a friend) have to stay in until 1 month after chemo ends.  (More on that below.)   I expect to have them in until the end of the summer which totally sucks since they are uncomfortable.   They will look like normal breasts in clothing but they make sleep difficult.

Based on what Dr. LG has said (and the surgeon at Memorial Sloan-Kettering), I will need to have chemotherapy after the surgery.   Type and duration is completely unknown and I probably will not know anything until after the surgery, although I will ask when we meet the medical oncologist, Dr. E, next week.  The biopsy only took a small amount of tissue for analysis.   The mastectomy will result in all (we hope) of the cancerous tissue so more extensive tests can be done.   If I have chemo, it would start about a month after surgery and I expect it to last 2-4 months (or potentially more). 

With the mastectomy, radiation is unlikely unless there is lymph node involvement or they can't get "clean margins" because the tumors are too close to the chest wall.    No surgeon has said anything about radiation so I am hoping and assuming I will not need it.

I think that is everything.  

Oh and thanks again for all the blog comments, emails and phone calls.   It is nice to know I am not alone on this crappy journey!