The “shark bite” surgery has been done! I am home, healing, and still feeling grateful.
I finished my last chemo on December 12th so I would be fully recovered and ready for this surgery. Josh and I went to Mayo last Thursday for all of the pre-op appointments and lab work to make sure I was good to go. They all agreed I was healthy enough and we were given the green light to proceed with surgery the next day, Friday, January 16th. We were told to plan on me staying in the hospital for possibly seven to ten days, depending on how the surgery went.
***If you are squeemish you might want to skip ahead to the next paragraph :-) The axillary lymph node dissection was done on both sides, as planned. They also removed my right breast (prophylactic mastectomy) and did the big “shark bite“/tissue removal of my left chest wall. A pathologist was present for that part of the surgery to make sure all of the margins were clear on the skin–and they were. The pathologist also briefly looked at a few nodes from the left side and saw at least two nodes that still had some traces of cancer–which is not a surprise. Because they found some that were positive, she proceeded to dig a bit farther down and found five more nodes. Naturally, a picture was taken at this stage of the operation (and of course, we asked to see it.) “Shark bite” is a pretty accurate description, but with smoother edges. The hole on my left side was a fair bit larger than what was drawn on me pre-operatively, but it had to be done. I think dinner plate size would be a pretty close comparison to the size of the hole on my left chest. It was huge! (I’m tempted to post the picture but maybe that’s too much??) When the general surgeon was done with all of that, the plastic surgeon took over and had the job of getting everything all back together. The plastic surgeon told us pre-operatively that he might need to use a device called Dermaclose to help get the skin edges back together. (If you click on the link–click on the “How it Works” section and watch the video clip! Yuck…) Basically, it’s a device that is programmed to slowly pull the edges of a wound together. Sounds awful, right? Well, fortunately, he did NOT have to use that!! He and his team were able to close most of the hole and used a flap of skin from my right breast to close what remained. I now have a large incision that runs from the left side of my back, across my chest, and ends under my right arm. Altogether, it was an eight hour surgery. A very long day for all involved and for all who were waiting.
I was really groggy Friday night after surgery and didn’t fully appreciate the extent of what had been done until Saturday morning when the doctors rounded. I was told normally a surgery like this requires two to four more trips to the operating room until the wound is fully closed. (Hence the projected seven to ten day hospital stay.) Since they were able to close everything up, I would likely be able to go home in a day or two. Their main concern was the condition of the skin flap. That needed to be watched closely for a while to make sure blood flow was sufficient. Like a good little patient, I was out of bed, walking (slowly and gingerly) in the halls, and sitting up in my chair for most of the day on Saturday. Sure enough, by the next morning, I was doing well enough to go home!
I am still in awe of how well the surgery went. There is no doubt in my mind that God got us to the right place and surrounded us with the right people to make all of it happen. I am so very grateful for the gifts and skills God has given to them!
The final pathology report has brought more things to be grateful for. There was no cancer found in my right breast and no cancer found in the 31 lymph nodes removed from the right side. Two of the 31 nodes showed ‘treatment effect.’ This means they can tell cancer used to be there (which we knew since August) but because of treatment–it is now gone. On the left side, 19 lymph nodes were removed and two had small amounts of cancer (which we already knew from surgery.) Those five extra nodes she dug for towards the end of surgery ended up being negative for cancer. From the chest wall, there was almost no cancer detectable. They found one itty bitty residual spot, but it was too tiny to grade. This is all great news considering that tissue had an awful lot of cancer in it in September! The chemo was effective and did its job.
It has been about ten days now since surgery and I am happy to report that recovery is really going well. I have some discomfort in my arms and on my left side, but it’s minimal and nothing worth complaining about.
Today, we finished up the post-surgical and oncology follow up appointments at Mayo. In the last two days, I saw general surgery, plastic surgery, physical therapy, radiation oncology, and medical oncology. All are very pleased with how well I’m healing. The question now is–where do we go from here?
I was kind of surprised, but the plan is now radiation.
I really thought since there was still just a tish bit of cancer left in those two nodes that more chemo would be recommended. However, we were told that piling on more chemo at this stage in the game wouldn’t necessarily be beneficial. He said my cancer has been acting very “local/regional” and feels that if there are still some microscopic cells left, they are likely going to be in my armpits/chest wall areas. Hence the radiation recommendation. It is comforting to know though that that this cancer responded so favorably to chemo. If it does come back, the option of chemo is still on the table and we know it worked. It was not fun…but it worked.
Back to the plan. The radiation oncologist spent a lot of time explaining the benefits and risks of radiating an area that has already seen radiation. Despite the risks, all members of my team feel the potential benefits are greater and that radiation needs to be the next step. He recommended five weeks of radiation. At Mayo…
My initial reaction was to break down and cry because I don’t want to be away from my kids for that long. Five weeks, Monday through Friday, five hours from home… Ugh.
I asked him if he could just make the recommendations and I would bring them to Fargo to have it carried out. He was incredibly kind, patient, understanding, and reluctantly willing to try but said that it just isn’t that simple. It was kind of interesting actually. In my mind, I’m just thinking–“you recommend the dose and the settings. I’ll go to Fargo and they carry it out. Boom. Not that hard.” He explained the differences in machinery, various different techniques, differences in physicians, and then humbly finished with “I’m a specialist in radiation oncology for breast cancer.” He also said there is new research that has shown three weeks of radiation may be just as effective as five and that might be a possibility. I left that appointment really bummed and said I would think about it…
Today, the medical oncologist helped me decide. He basically echoed everything that was said previously, but explained that my situation and cancer are very unique. Radiating areas that have already seen radiation is not uncharted territory, but it is not something that is done routinely. It is very specialized. I think maybe hearing it presented in a different way helped and made it more clear to me why it needs to be at Mayo. So the plan, at this point, is three weeks of radiation at Mayo starting mid-February. I don’t love it, but we can deal with it and hopefully it will do its job and decrease the chances of this cancer coming back. (At Mayo, they all say “cross your fingers” or “knock on wood.” I say PRAY…)
The last thing that was decided today was–how are we going to monitor and follow-up after radiation? After reviewing the options, my oncologist graciously left the final decision up to me. After being burned by that tumor marker blood test, I said I’d feel most comfortable with PET scans. So, about every four months, starting in May, we’ll do that. I know a PET scan isn’t perfect (I’m told spots need to be about 1 cm or larger before they can be detected) but I think it will bring me the greatest peace of mind. So that’s that!!
I know I sound like a broken record, but we have so much to be grateful for. We are so thankful for the skills God has given to my medical team and SO grateful that He put me in their capable hands! It is not fun driving to Mayo, but how blessed are we to have it so accessible in our state?! ***I can’t believe I forgot to add this HUGE thing to be grateful for too: We have awesome friends who live in Rochester and they have graciously invited me to stay with them during radiation. This takes away a tremendous burden and we couldn’t be more grateful to Jenny & Mike!***
We are also thankful for the unbelievable amount of love, prayers, well wishes, and financial support that have been given to us. We are overwhelmed by your kindness and generosity. Absolutely overwhelmed… There are no words that could adequately express our gratitude.
With deepest and heartfelt thanks,
Cassie & Family