5 days ago, my breasts were surgically removed. This is known as a double or bilateral mastectomy. I reached remission about 8 weeks ago after undergoing an oncoplastic reduction. My surgery included removal of the tumor (aka partial mastectomy or lumpectomy), sentinel lymph node dissection and a bilateral breast reduction. Oh, I also had an ovarian dermoid cyst, ovary, and fallopian tube removed as well as my port. That’s a mouth full, let’s break it down.
The purpose of oncoplastic reduction is to remove the tumor bed and evaluate for any remaining signs of cancer and requires several steps prior to the actual procedure. On the morning of my surgery a radiologist identified my tumor using ultrasound and injected a radioactive seed into it to help my breast surgeon visualize it accurately later in the OR. Then another radiologist injected a radioactive tracer at the edge of my areola – albeit a brief burning and stabbing sensation, this injection was the most painful one I’ve had. This tracer, in addition to a blue dye injected into my breast in the OR and a special imaging technique called lymphoscintigraphy allowed my breast surgeon to identify my sentinel lymph node.
The sentinel lymph node(s) is the first lymph node that the affected breast drains to. It is removed to be evaluated for cancerous cells. Theory being that if the cancer were to spread from the breast, it would go through this particular lymph node first. So, if this lymph node shows cancer cells then it indicates that the cancer has spread outside the breast. This has largely replaced the previous practice of removing all the lymph nodes that the affected breast drains to, which was a more aggressive technique that is associated with side effects like lymphedema (swelling in your arm or leg).
My breast surgeon also removed my port, which I was arguably most excited about. It wasn’t something I ever wanted or identified as part of my body. It made me feel sick before I actually was ill from chemo. And as long as it remained in me, I had a lingering fear that somehow, someway chemo would flow through it again. It’s removal finalized in my mind that my chemotherapy really was done.
Next up was my plastic surgeon who reduced my left breast to match my new right breast. Then my gynecologic oncologist laparoscopically removed my ovarian dermoid cyst which was incidentally found during my initial work up of breast cancer. The large size (6cm) made it high risk for an emergent condition called ovarian torsion, so it was recommended to be removed. Unfortunately, when my surgeon opened me up, she noted that the cyst indistinguishably engulfed my ovary and thus my ovary and fallopian tube were also removed. Of course, this was a possibility that she had discussed with me at length prior to surgery to prepare me. It is what it is.
It is unbelievable the immense collaboration that was required between 2 radiologists and 3 separate teams of surgeons to make this possible for me all on one day. Not only that, my radiologists, oncologist, breast surgeon, plastic surgeon, gynecologist oncologist, and anesthesiologists – all women! Surrounded with love, compassion and encouragement, I headed into surgery with minimal hesitation.
The entire affair was led by my breast surgeon, the amazing Dr. Christine Teal – Chief of Breast Surgery at George Washington University and quite the inspiration herself. In 2010 she chose to undergo a prophylactic bilateral mastectomy after experiencing her mother battle breast cancer twice. She made this decision without being diagnosed with cancer herself or being tested for the BRCA gene (BReast CAncer gene). This was also before Angelina Jolie’s prophylactic bilateral mastectomy in 2013. The media coverage surrounding Jolie’s move, based on being BRCA positive, increased the public’s awareness of this option and made it seem less radical. But Dr. Teal was a trailblazer before Jolie. With true humility and an unbiased approach to her patients, Dr. Teal never mentioned her story to me. I found out by my Dad who forwarded me her moving and insightful feature in The Washingtonian -> HERE <-.
1 week after my first surgery the results of my surgical pathology evaluation of the tumor bed and sentinel lymph node were negative for any signs of cancer. Hence, I reached remission.
Remission could have been the end of my breast cancer journey. However, my biggest concern going forward was the risk of recurrence. I wanted to ensure to the best of my ability that I would never ever have to go through this again. Based on the characteristics of my breast cancer I was quoted a 1% risk of recurrence per year which accumulates each year! Meaning in 5 years, 5% risk of recurrence; in 20 years, 20% risk of recurrence.
HELL NO!!!!!!!! Not acceptable to me. I may have felt differently if I wasn’t in my 30’s. Without hesitation I pushed on to have both my breasts removed. Since there is no such thing as “never” in medicine, even with a double mastectomy the risk of recurrences is approximately 3% over the rest of my lifetime. This is the lowest possible risk I can obtain through my control. So, bye boobs.
Kavita Jackson, MD