After a long day at UCSF on Friday that culminated in a meeting with the lovely Dr. Ewing the breast surgeon (no really, she truly is lovely, as is her staff, and for that I am extremely grateful), nothing has changed but things are clarifying more. She agreed with the assessment of Dr. Fowble (the radiation oncologist) that my previous radiation treatments had likely contributed to the occurrence of this breast cancer, and that the possibility of the same thing happening to the other breast was therefore significant. So double mastectomy it is. She also gave me information about the different choices I would have for reconstruction, which basically came down to nipples (which would mean a longer overall process and involve an additional surgery for a total of three surgeries before I'm done) or no nipples (shorter process, two surgeries total).

These decisions are really hard. Part of me just wants to say "take off the breasts and let's be done with it, I'll learn to live with and love a flat chest", and not even mess around with reconstruction. But the other part of me that has been a big-busted, hourglass figure girl all her life feels like it just wouldn't be satisfying to live my life without something up top to balance the bottom. So much as I HATE the idea of additional surgeries and dragging this process out longer, I think I am going to go with the nipple-saving process, because I'm pretty sure that future me will appreciate the end result more.

I am supposed to meet with a plastic surgeon sometime next week, and that will hopefully result in some additional info for me about the details of how the reconstruction process will go and exactly when the surgeries will happen, but for now my understanding is that it'll go something like this. First, hopefully around the beginning of November, I will have a surgery to remove the cancer and at the same time reduce the size of both breasts. That will take about two weeks to recover from but then I will have to wait and let the reduction heal up for six months, and then after that I will have another surgery which will be the full double mastectomy and the insertion of temporary "stretcher" implants. I will recover from that and keep stretching my skin for a couple more months and then have a third surgery to insert the permanent implants.

The wild card in this process that we can't know for sure yet is whether or not I will also have to have chemo treatments. The MRI and ultrasound tests I've undergone seem to imply no obvious involvement of the lymph nodes or anywhere else, but the only sure way to tell that is a biopsy of the lymph nodes that happens during surgery. If the pathology report comes back showing clean lymph nodes, there's a decent chance I won't have to do chemo (or just a "light" dose). If it comes back with cancer found in the nodes, I will likely be advised to do a round of chemo, and the reconstruction will have to wait until after that process is finished and I'm healed from that.

There is also still a potential wild card floating out there with the results of the genetic testing. If that test shows any sort of conclusive mutation that might also put me at risk for ovarian cancer, they may also want to remove my ovaries during that first surgery (which means instant menopause). I guess the thinking here is "better to recover from everything all at once" rather than add yet another surgery to the list, and an oophorectomy (what a word) would be done laproscopically so it's not actually that much more added to the recovery process (except for the menopause part, but that's a different story with different solutions and frankly I'm still hoping to not even have to think about that story just yet.)

As someone who went into this with a fairly large fear of surgery leftover from the first go-round with cancer, the idea of having to go through multiple surgeries is scaring and saddening the shit out of me, but I am wrestling with it and reaching for courage in the face of future adversity. Because what else can I do? Can't really say no and can't run away, much as I'd like to right now. I know I can do this, and that eventually it'll all be over and I might even be grudgingly pleased with the aesthetic results (I know for sure I'll be mighty pleased with the surviving part). But wow is this a hard fate to accept (especially with the knowledge that it was my decisions around treatment in the first go-round that led me to the treatments I have to live with now). Cut off my breasts? I don't wanna, I don't wanna, I don't wanna! But I wanna keep living more than I don't wanna hurt, so courage must (and will) be applied. Any and all help in keeping that courage strong and sustained will be gratefully accepted.