Booby or no booby?

The call finally came in Tuesday from Dr. Butler's office. They recieved the pathology report, which was put on "rush." We set up an appointment for Wednesday evening with the doctor to review what they had found.

This time, I acquired an extra hand to come with us--as I mentioned earlier, my mom and I ended up with conflicting stories following the last appointment with Dr. Butler. So, this time my aunt Cathy Anne decided to come with us. Last time Mike waited in the waiting room simply because I thought the doctor wouldn't like a flock of people piling in his office, but this time I told him he could come too. The more people, the more information we could soak up. So, when the doctor called me in this time, there was a crew of people behind me. He thought this was quite amusing.

Down to business. The doctor immediately went into the details of the report:
They removed the tumor and some of the tissue surrounding it, and both were tested. The tumor was indeed Invasive Ductal Carcinoma (the most common form of breast cancer) and was approx. 1 cm in size when they removed it. The largest edge was 1.3 cms. If you have been reading well you will recall that the reports from Korea stated that the tumor was .67 cms. This leads me to believe that one of two things could have happened: 1) The ultrasound didn't pick up the full size of the tumor (which is quite possible since it is not 3 dimensional); or 2) The tumor grew QUICKLY over the past 2 weeks. If the second scenario is indeed the case, then I am extremely glad I was insistent in getting it removed as soon as possible. I am also glad I did not delay a second in getting back to Canada from South Korea.

But this wasn't the only news. The surrounding tissue that was tested was also positive for cancer. However, this cancer was the non-invasive or "in-situ" type (the type that is contained in the ducts, is not spreading, and is not immediately threatening). Although it was DCIS (ductal carcinoma in-situ), it still needed to be removed. This is because DCIS eventually becomes invasive if left long enough. The doctor couldn't be sure that he removed all of the non-invasive cancer in the tissue he took, so further surgery was required. YIKES! I have to go through all of this again?

I was, however, given an option. The first option was to remove a small piece of the breast. This would preserve my original breast, but could have drawbacks: 1) If the margins were not clear (meaning, if they still weren't sure they removed all of the cancer after removing the second piece of tissue), I would need to go in yet again for another surgery; 2) I would need an extended radiation treatment following to be sure no cancer cells were left behind and still lingering in the breast; 3) I could quite possibly be left with a mutilated looking breast (what the doctor called a less-than-appealing "cosmetic result"), mainly because I have small breasts; and 4) Even if everything went well, I could quite possibly be haunted by the breast for the rest of my life--wondering if there are lumps, if cancer is still lingering, and what is going on inside there.

The second option would be to have a "modified radical mastectomy," where the breast is completely removed and all chest muscles are left in-tact. As soon as I thought of having my breast removed I became disguisted. Just to think of myself with one boob and a large scar across my chest sent shivers through me. This was the major drawback of the second option. And it is definitely a large and quite significant drawback. There were benefits, however: 1) Definitely no more surgery (unless the cancer was to recur down the road, which is possible for both scenarios); 2) Radiation treatment might be an option, but would not be necessary; 3) I would have the piece of mind of knowing that the breast was gone-- no worrying about what might be brewing beneath; and 4) MSI offers free reconstructive surgery following treatment. Dr. Butler told me this would be in the form of a breast implant, and he assured me that the plastic surgeon who does it is excellent, and the results are usually beautiful.

With that, I was to make a decision. These are decisions that would affect the rest of my life, and were not to be taken lightly. Both scenarios had there benefits and drawbacks. Scenario 1 had a large benefit with a number of drawbacks, while scenario 2 had a one large drawback and a number of benefits. Boob? or No Boob? Or as Craig the anesthesist would say: Booby? Or No Booby?

I told Dr.Butler that this was a decision I would need to think long and hard about. He suggested reading the dreaded "Patient's Guide to Breast Cancer" book he gave me the previous week to learn more about the pros and cons of each option. He told me, however, that if I decided by early tomorrow morning (Thursday) he could have me in Friday (just 2 days later!) for the surgery. Otherwise, he would perform the surgery the following Friday.

Decisions. Decisions. Decisions. And I thought I had tough decisions to make before this happened ...