[2021-09-08] 2b continued
As a follow-up to my June 2 consultation with Dr. Cordeiro, Breast Surgical Oncologist at The Ottawa Hospital, I met today with Dr. Simon Frank, a plastic surgeon with The Ottawa Hospital who specializes in, among other things, breast reconstruction.
If I proceed with a prophylactic bilateral mastectomy (removal of almost all my breast tissue) coupled with breast reconstruction (insertion of implants) to reduce my risk of developing breast cancer, Dr. Cordeiro would do the first part of the surgery and Dr. Frank, the second.
As a reminder, I am considering a mastectomy because of my faulty BRCA2 gene, which puts me at a 50-85% risk of developing breast cancer. While I could opt for annual breast screening in the form of a mammogram and breast MRI (which I described as Option 1 in my post 2b or not 2b), this option would not prevent breast cancer or decrease my risk of getting it. It would simply detect breast cancer early. To use an analogy, annual screening would not prevent the horse from escaping, only notify me early that the horse has left the barn.
Not wanting to face cancer—again—and to go through cancer treatment—again—I continue to believe that Option 2 (surgery) is the way to go. In my June post, I identified three sub-options for surgery: (a) no reconstruction, (b) reconstruction with implants, and (c) reconstruction with my own tissue.
Dr. Frank did point out that choosing 2a now (no reconstruction) would not preclude 2b (reconstruction) in the future. While it would be more complex to go from 2a to 2b, it could be done. But I still remember what Dr. Cordeiro said in June: the advantage of reconstruction is that "you go to sleep with breasts and you wake up with breasts." I believe that, psychologically, this would be an easier transition for me. Dr. Frank concurred.
The reverse is also true: choosing 2b (reconstruction) would not preclude 2a (no reconstruction) in the future. I could get breast implants at the time of my mastectomy and, if I encounter problems in the future, I could opt to have the implants removed. When I mentioned this to Dr. Frank, he agreed.
As Dr. Cordeiro suggested might be the case, Dr. Frank confirmed that option 2c (reconstruction with my own tissue) is not really a viable option for me for two reasons: (1) I have little extra fat on my body, and (2) I have already had surgery on my abdomen, which is where he would normally take tissue to reconstruct my breasts. While the level of satisfaction with Option 2c is typically high, he said, it's a much more complex surgery than 2b, requiring 10-12 hours in the operating room, 3 days in hospital and a longer recovery period. By contrast, Option 2b would entail 3-4 hours in the operating room, no overnight stay in hospital, and a complete recovery period of 6-8 weeks.
With respect to Option 2b, Dr. Frank provided two sub-options for the placement of the implant: (i) under the chest muscle, and (ii) on top of the chest muscle. One of the advantages of the latter approach, which Dr. Frank recommended, is less chance of implant distortion when flexing the chest muscle. This approach has been used for 5 years, he told me.
So 2b remains the leading contender, with 2b(ii) the most likely choice.
Any surgery of this type is not without its risks and potential challenges. For example, if Dr. Frank determines during the surgery that the blood flow in my breast skin is not sufficient, he may need to insert a smaller, temporary implant, allow the skin to heal and then, in a second surgery, insert a full-sized, permanent implant. This happens in about 5-10% of reconstruction surgeries, he said.
I could experience a breast infection, which would likely come to light within 1-2 weeks of surgery, necessitating a second operation. In such a case, the surgery would take less time (1-2 hours) and the recovery would be faster (1-2 weeks) than with the original operation.
I could be unhappy with the result, which would be reviewed as part of the 6-month follow-up. Throughout the discussion, Dr. Frank spoke in a way that made me feel that if I weren't happy with some aspect of the final product, options would be available and he would be there to implement them.
Today's discussion was not about answering every question. For me, it was about confirming the right option. The next step is a second discussion with Dr. Cordeiro, followed by another one with Dr. Frank.
As I embark on this next health journey, I will continue to share my experience and my understanding. Even though I'm not a medical professional and may not accurately capture all the details of my conversations with various doctors, I feel that there is as much value in sharing updates on my efforts to avoid breast cancer as there was in talking about my steps to address ovarian cancer.
