19. Preparation for Surgery
It was after my fourth chemo cycle that the thought of the impending surgery crept into my mind. It was always there, but now it was getting closer. I knew the two options were a lumpectomy or mastectomy. What was going to happen I just had to wait and see. From the beginning of the cancer path everything is taken out of your control. For me, as I’ve said before, I was rarely sick, so to go from that to full on medical treatment, it’s a head wreck. It evidences to you your adaptability. I had no choice in any of this, everything was completely outside my control. As a person who likes to know what they are doing, where they are going, what seat they’ll be sitting in, everything was taken out of my control. Even when I went into the treatment room I was showed where to sit. I didn’t mind any of this, because everything was done with my best interests in mind. I was treated so well and respectfully and because of that nothing was a problem. In a situation that was completely out of my control, I felt safe as the best decisions were being made for me and my circumstance.
Thinking of the surgery it wasn’t the operation so much, or loosing a boob that was necessarily causing me the worry, I would say that I wasn’t that attached to my boobs, they were attached to me. While I was ok with the possibility loosing a boob, I was still concerned about it and didn’t know the impact it could possibly have on me, but I thought I’d rather no boob than the possibility of recurrence. I spoke to my oncologist about which option would be best to prevent recurrence and he said whether lumpectomy with radiotherapy, or mastectomy, the results and outcome were the same. He explained the surgeon would remove the bed of the tumour and if he had to remove more than a certain amount then he would have to do a mastectomy. He continued that biopsies of the lymph nodes would be carried out. He told me if the lumps could safely be removed then that was what would be done with radiotherapy, which would take place daily over two weeks. My mind was spinning!
The meetings then started to discuss surgery. I met my new consultant. He was very approachable and easy to talk through the options. At first talked about the possibility of there being a decision about lumpectomy and mastectomy. The option of a mastectomy also had the option of reconstruction by implant or reconstruction using tissue from the stomach. The latter required two operations, one in Derry to remove the tumour bed and then reconstruction in Belfast. Again, completely inappropriately I joked I could get two for the price of one; a boob job and a tummy tuck! Paschal knowing my humour laughed, the consultant and breast care nurse graciously chuckled. He continued providing information and said he thought from my response I would go for the mastectomy and tissue reconstruction. I replied at that point my decision was resting closer to mastectomy and remaining flat, no reconstruction. The decision making for this can only be a personal one. For me
· I was nearing 50, so while looking nice in clothes, while still important was not as important to me.
· I didn’t want to go through two separate operations and recovery would be a lot longer.
· I just wanted the cancer gone, the rest I didn’t really care about.
· As with all surgery I understood there could be a greater chance of complication, I had been through enough and the thought of over complicating it further was just too much at that stage.
· Prosthetics seemed to work pretty well, I would be content with using one of those purely for the aesthetic of clothing, otherwise I would come to terms with it.
· As I’ve said my boobs are attached to me, I’m not that attached to them!
As part of the appointment I had a mammogram done. After viewing it the consultant returned to say due to the size of the area that would have to be removed, he was unsure if there would be any decision. He said it could be an automatic mastectomy as for an area of 4cm a mastectomy was usually recommended. He said 10 years ago it would have been an automatic decision for mastectomy but he would discuss it at their multi-disciplinary meeting to see if there was an option and we’d meet again. Then there would be a decision about reconstruction/no reconstruction. However, I was told lumpectomy is equivalent to a mastectomy in terms of life expectancy and slightly better than a mastectomy in terms of recurrence.
I left that appointment sure that the outcome was going to be a mastectomy. I talked to Paschal saying it looked like a mastectomy. Paschal asked me if that was what I heard the consultant saying, because he heard it differently. He said for the first part of the meeting, to him, it seemed very balanced, 50/50 for each, but after the mammogram he said it seemed to be more likely to be a mastectomy, but not definitive. I hadn’t really heard that. I went into the meeting with my head set on having a mastectomy because I wanted the cancer gone and I don’t want it to come back. Listening to Paschal I realised I was being blinkered and I needed to give this more thought and be more balanced in my decision making. This is the value of having someone go to meetings with you, they can give their interpretation of what is said, which allows for more questions, rather than just arriving at an anxiety based, ill informed decision. In the most, if you can, have someone go to meetings with you, who can listen objectively.
After the meeting with the consultant I really didn’t know what to think, would there be a choice, would there not? Time would tell. You just go through the motions during cancer, things seem to become matter of fact. Should I have my boob cut off, or should I just have a bit of it cut out? Should I have tea or coffee? It sounds quite crude but in reality that’s what was going to happen. The way I saw it my boob didn’t have any serving function in my life. I didn’t need it to live or survive, without it I would function just fine and there was always prosthesis. Although my thinking at the time was to remain flat, after the conversation with the consultant I wanted to find out more about reconstruction to help me make a more informed decision. I was basing my thoughts on anecdotal information from people who had never experienced cancer nor had breast surgery.
Until this point, although I could talk about cancer, I hadn’t really spoken to anyone who had experienced cancer. I hadn’t spoken to anyone openly about their experience of surgery, be it a mastectomy or lumpectomy. But it was two days before my next meeting with my consultant and I thought I should talk to people who had been there and who knew the outcome. I left it so long to talk to people simply because I wasn’t ready and I couldn’t. I had been through chemo, I knew what was happening, but I wasn’t ready to truly face upto the reality of what was happening. Someone much cleverer than me could explain to you the whole theory of dissociation, something I was familiar with through my work, but something that I was very aware I was doing to cope with what was going on. However, I had to face up to it at some stage and that time was now!
My little decision making helper!
I contacted friends, and family friends, who I knew had been through something similar. Everyone was willing to talk to me and everyone was open and honest about their experience. Some of the people I spoke with hadn’t had cancer themselves but carried the BRCA gene which increased the risk of them developing cancer, so they voluntarily had a mastectomy. I learned so much from other people and their brave decisions. Some much braver than mine particularly those who underwent a voluntary mastectomy. I had no choice in my decision, but for them they had a choice, but perhaps, like me, they felt they didn’t.
Each person gave me as much information as they could about the reasons they made their decision of either mastectomy or lumpectomy, which in turn was helping me make mine. From everyone I spoke to their lives had continued, therefore it was evident to me there is life after cancer, and it goes on. One person talked to me about their experience contacting the Someone Like Me service provided by Breast Cancer Now. I was also assured that I when I next met my consultant, I didn’t have to have my final decision made. Although I knew I couldn’t take forever to make my decision, it would have to be made, I had no option.
What struck me at that time, and in the most, when I spoke about having cancer, or talked about cancer, I could hold back the emotion and cover up the fear I had, I was able to do this by being matter of fact, saying things like there was no plan B, only plan A which was cancer had to go, it had no place in me. Also a lot of my conversations were on the phone so I could hide, in as much as I could, the feelings. Although I also knew I couldn’t hide them forever. I’m an emotional person but I knew I had to deal with the facts as a means to get through the most difficult of time.
