Lumpectomy and Then What?

temp-post-imagePhew!!! The decision was finally made – I was to have a lumpectomy of my right breast to remove the known cancer. A lumpectomy usually removes the least amount of breast tissue. The surgeon removes the cancer and a small portion or margin of the surrounding tissue, but not the breast itself. They also chose to remove an area of dense breast tissue called a fibroadenoma. Fibroadenomas are common benign (non-cancerous) breast tumors made up of both glandular tissue and stromal (connective) tissue. Fibroadenomas are most common in women in their 20s and 30s, but they can be found in women of any age. They tend to shrink after a woman goes through menopause. Dr. Kahn said it wasn’t necessary to remove the fibroadenoma but I figured if it was going to cause me potential trouble in the future, why not

take it out while they were in there?

In addition to the lumpectomy, I made the decision to have breast reconstruction/augmentation – I wouldn’t want to be “lop-sided”, but there were upsides and downsides to this decision and as a result, I had to put in contingency plans, in the event that the surgical pathology suggested a different treatment option would produce a better outcome.

Plan A: Lumpectomy with Intraoperative Radiation (IORT) and oncoplasty. Intraoperative radiation therapy (IORT) is a treatment for cancer in which the radiation is delivered directly to a small area of the body, all at once. This is different from the usual method of delivering radiation, in which a larger part of the body (such as an entire organ) receives radiation for a longer period of time. Oncoplastic surgery combines the latest plastic surgery techniques with breast surgical oncology. When a large lumpectomy is required that will leave the breast distorted, the remaining tissue is sculpted to realign the nipple and areola and restore a natural appearance to the breast shape. The opposite breast will also be modified to create symmetry. This is a good option for patients who are candidates for breast conservation therapy or lumpectomy, and are also candidates for breast reduction or mastopexy (breast lift).

I’d get out of this mess in one day. You have no idea how hard I prayed for Plan A to come through for me.

Plan B: If the pathology of the tumor didn’t qualify for IORT, meaning if it was bigger than anticipated OR they found cancer cells in my lymph nodes, they would have to abort IORT and stick with removing the cancer, the lymph nodes, perform oncoplasty and augmentation as in the original plan. The most depressing downside of this option was that it meant I would most likely need to take the traditional, scientifically proven route, chemotherapy and radiation. It would be a long road ahead of me.

I had to hope and pray for the best, Plan A, and be prepared for the worst - Plan B.