[2021-09-22] 2b goes on
Today, in preparation for a follow-up call with Dr. Cordeiro, Breast Surgical Oncologist at The Ottawa Hospital, I did some research so that I would have good questions for our discussion. This was my second consultation with Dr. Cordeiro about a possible prophylactic bilateral mastectomy with reconstruction. Simply put, such surgery would entail the removal of almost all breast tissue to help prevent breast cancer and its replacement with breast implants.
As a carrier of a BRCA2 gene mutation, I am at high risk of developing breast cancer: 50-85%. Removing the breast tissue would reduce that risk to 3-8%.
In June, I spoke with Dr. Cordeiro (2b or not 2b), and, in September, I met with Dr. Frank, a plastic surgeon with The Ottawa Hospital who specializes in, among other things, breast reconstruction (2b continued). Should I proceed with the operation, Dr. Cordeiro would remove the breast tissue and Dr. Frank would install the breast implants and perform the plastic surgery. I learned today that each doctor has done about a thousand such surgeries.
Having done some research and chatted earlier this week with a woman who has gone through a similar procedure because of breast cancer, I decided to delve into the things that can go wrong with this type of operation, the level of risk and the mitigation.
- The first risk Dr. Cordeiro mentioned was bleeding and infection—risks that are common to all surgeries. Such risks materialize in about 4-5% of mastectomy surgeries.
- The second risk was insufficient blood supply to the breast skin. This occurs in about 5-10% of skin-sparing mastectomies. Because of my previous breast surgeries (for recurring breast infections 20 years ago), I am at a slightly higher risk of this complication. In most cases, insufficient blood supply is dealt with using wound care. In rare instances (about 1%), further surgery would be required to remove the implant and any dead tissue.
- The third risk was insufficient blood supply to the nipple, which Dr. Cordeiro said occurs in about 4-5% of nipple-sparing mastectomies. The remedy is frequent dressing changes. If this didn't work, the nipple would need to be removed, which happens in 1-2% of cases.
I'm not a healthcare professional, so I may not have captured, with complete accuracy, everything Dr. Cordeiro said. Nevertheless, she did note that of the thousand or so surgeries she has done, only a handful of patients have experienced serious issues, which are quite rare. That was encouraging.
Today's conversation was also an opportunity to manage expectations. Dr. Cordeiro emphasized that the point of reconstruction is to make the patient feel comfortable with her silhouette while wearing clothes, not to create breasts that will look perfect when the patient is naked. She also reminded me that the breast area would be numb and that I could experience tightness in the chest muscles.
While this may sound discouraging, I am keenly aware that none of the options available to me is without risk. I continue to favour option 2b: mastectomy with reconstruction using implants.
I will meet with Dr. Frank for a second time next week. I will likely need another mammogram and breast MRI before surgery proceeds, possibly in six months.
Dr. Cordeiro said that the best thing I can do to prepare for the surgery is to be as active and as fit as possible. That I can do. Though it sometimes feels like so little is within my control when it comes to cancer and cancer prevention, opting for surgery is one more way I can make every effort to stay alive.
