the next steps

All right. Sit back and I'll try to go over the details of the last 3 days.

Tuesday we saw the plastic surgeon. He is the only male on the team and although he is skilled, kind, thoughtful, and entirely professional, this one area of the many discussions is perhaps the hardest for Becca to discuss with a man. That area being, to put it bluntly, "how my boobs will look". Becca went in with her list of questions and was ready to just bite the bullet and ask away, but then we first met with a very knowledgeable nurse who works closely with the doctor. And she was a woman. So what happened basically is that Becca asked the nurse all the questions, and it turned out to be a warm-up for just asking them all over again with the doc, at which point he answered them almost the same way but with a bit more technical detail when warranted. A perfect process for Becca, and looking back I suspect it was not chance that it was set up this way.

So what was found out? First let's step back and go over what this week needed to produce for us. The major decision Becca has been laboring over is the one-or-two question.

At the beginning of all this when it was all but assumed that she would have one or both of the BRCA genes, the bilateral option seemed probable, and ovaries might be removed as well. But then came the genetic variant of uncertain significance result. That threw us, and what we learned from our onc is that given this result, there is a less-than 1% greater chance that a new cancer will develop in the second breast. (And we are only talking about new cancers; the first one does not "spread" to the other breast - breast cancer doesn't work that way.)

We also learned today from the surgeon that in current studies there is next to zero survivability impact of leaving the other breast alone. In other words, survivors of a first occurrence almost always survive a second occurrence. The surgeon noted that this is perhaps because of the fairly strict mammogram, etc. regimen you are on after the first occurrence; early detection is practically guaranteed.

I should note here that each doctor to a T was careful to say that he or she could not make this decision for Becca; all they could do was give her all the information that is known presently and what the treatment ramifications are for each decision. There are many different and equally valid ways women deal with this type of a decision. Very personal factors coming into play include degree of worry-toleration post-treatment, body image, and chemo-therapy experience, just to name a few.

Anyway back to the plastics office. The procedure that Becca has decided upon is called a DIEP-flap. If you want to learn all the nitty-gritties you can visit the practice's web site here. The important things we learned here are that 1) with this procedure there is no danger to singing apparatus 2) The DIEP-flap procedure can only be done once. So a bilateral decision is optimally made beforehand. (Other procedures are available of course if there is a need for a second reconstruction after a DIEP has already been done) And 3) The range of options for achieving symmetry, etc. after the first surgery, no matter which option is chosen, is so wide and effective (and insurance-covered) that any cosmetic worries about only doing one side are rendered moot.

So there's Day 1. Then Wednesday, otherwise known as LAST CHEMO DAY, was chemo as usual plus a visit with the oncologist, where after another exam she maintained her "dramatic response" analysis. We also went about scheduling next week, which is turning out to be Scan Week. It is finally time to see how well the chemo has done in pictures. Bone scan and CAT scan, just as in December, with the results reported to us in a visit with the oncologist Friday. (We could use a cat scan at our house, too. Still no sign of George, alas.)

Also note that the Herceptin regimen continues starting in 2 weeks. Herceptin is not technically chemo but it is the same drug that has been given along with the chemo (Taxol) for the past 12 weeks. It has no side effects, except perhaps heart rigidity, which is why Becca is also due for an echocardiogram Friday just to make sure everything is still fine there. Herceptin will continue every 3 weeks for another year.

Ok so that brings us to today and the breast surgeon. The one revelation we had there other than the survivability statistic mentioned above was that the one-or-two decision does not have to be made before this surgery. WHAT? you say. But I thought... But the DIEP can only be done once... But... But... Well here's the thing. Radiation is also in Becca's future. Because of this, the full DIEP procedure can't be done until after the radiation is done. Therefore our plastics doc will be on hand to insert what they call a tissue-expander, but this is just a placeholder until the actual DIEP procedure is done later. Therefore, Becca actually has until that operation to decide whether to involve the breast surgeon again and have the bilateral completed along with the DIEP. Get it? I barely do. No I get it. I think.

Also, the surgeon thought it likely that we will be meeting with a thoracic surgeon to talk about what might be in store for the sternal area. This is not set in stone because a lot depends on what is seen on the bone scan next week. It might be left up to the radiation regimen, or it might demand a surgical component as well (which would be done during June's surgery). Wow, we might have 3 surgeons in there at once...

And the last thing is that June 8th is no longer the target date. Due to the scheduling needed, June 29th is the new target. Which gives Becca a very nice June indeed and puts us well out of the kid-birthday and reunion range.