Tit for Tat

Come on, I had to use that post title eventually ;)

Okay, so we have a tie! 2 surgeons say mastectomy, 2 say breast conservation and the 5th doc that was to be the hoped for tiebreaker says…drum roll please -- I can have either one!

By the time I got to the fifth (and last) oncological surgeon today I was already armed with lots of knowledge, a list of pertinent questions, and have become an old hand at the whole consult thing…and granted that may have been part of what made the visit go so smoothly. But I have to say I also liked her. She was friendly and easy to talk to and seemed to understand all my questions and not pass judgment on personal stuff like breastfeeding. She also was willing to give me objective data on my choices. She will do either surgery I want, with one caveat – she said “they” (and I’m assuming she means that hospital) will not do nipple sparing mastectomies -- something I have discovered in my research and want to know more about.

(Perhaps this post should have been titled, “How many times can Kayleigh use the word nipple?”)

See here’s how I see it in my ignorant laywoman’s mind:

Clearly one of my options is to have breast conservation that leaves me my own nipple essentially intact, perhaps with a significantly reduced breast size & deformed areola.

On the other side of the coin the kind of mastectomy I am a candidate for is what they call a skin sparing mastectomy, where they basically leave my entire breast intact on the outside and just take out all the bad stuff inside plus remove my nipple/areola. (what they put back in to make me a breast will be the subject of another post, but suffice is to say I might get a tummy tuck out of this deal!)

So then why can’t I have a nipple-sparing mastectomy as well, which seems to me to amount to the best of both those worlds? I mean, really…I just want my cancer gone, a normal sized breast, and my own nipple, which will hopefully still work, (and I mean in that special fun way)…is that so much to ask???

Okay, well, it may be, yes, lol. And to even have the possibility of asking questions like this is pretty freakin’ amazing considering a couple weeks ago I was vacillating between either planning my funeral in my head or imagining myself as some sort of one-breasted Amazon warrior.

But I digress.

In my research thus far the explanation for why they didn't do nipple-sparing mastectomies in the past was concern about microscopic cancer cells being present there since most cancer is ductal and all ducts lead to the nipple. The reason that isn’t a concern in breast conservation surgery is because they zap what’s left of your breast with radiation to kill those nasty little buggers just in case. However, with a mastectomy typically there’s no radiation, thus any stray little mutant cells left behind in a nipple could theoretically slip by and cause trouble later on.

But in recent years more and more nipple sparing mastectomies are being done because it's thought that the original concern over that area being more prone to cancer cells was exaggerated. Plus I've also read that they can actually zap the nipple & areola with radiation for a nipple sparing mastectomy just in case – and even can do so during the actually surgery!

In any case, clearly people are offering to leave me my nipple in breast conservation, so I need strong convincing arguments as to why not so with mastectomy before I can make my decision. I also feel like there are perhaps policies…formulas being used to determine what can and can’t be done rather than taking things on an individual health basis. The wheels of medical progress can move slow…I’m just trying not to get run over by them.

BOTTOM LINE:

If I choose to keep my nipple I need to know what cosmetic realities I will have to accept for my breast in order to do so, and if I choose a mastectomy where my nipple is taken forever and replaced with a replicated facsimile I want to know that it wasn’t possible to save it.

So, my quest is not quite done yet.

I am seeing two plastic surgeons, one tomorrow and one next Thursday. I am hoping they can answer my questions about the final cosmetic outcome, complete with pictures of their previous work.

In the meantime I do feel pretty well armed with knowledge about my health prospects, which is what’s MOST important. My prognosis is good thus far so I try as much as I can to focus on that, especially for the sake of my little family.

Will update soon as I can…much love and great big fat gobs of gratitude to EVERYONE. Thanks for coming along on this journey, it would have been so much harder without each and every one of you :)