Here We Go Again

HealSpring 2008
Volume 2
Issue 1

Surely it couldn't have been that long since my last mammogram.

The story explored new research indicating that breast cancer survivors become lax in getting their annual mammograms on their unaffected breast.

As I read through the information, I realized that I hadn’t gotten my 2007 mammogram. It was almost November, and I always schedule my breast health checks in October, Breast Cancer Awareness Month and the month my breast cancer was diagnosed in 1986. Then it hit me that the only medical event I could remember in the fall of 2006 was a detached retina that required surgery. Surely it couldn’t have been as long ago as 2005, I thought. Sure, I was busy with two jobs and speaking, but I must have had my mammogram. Then I froze. In 2005 I had two hip replacements, one in August and one in December, and I did not remember scheduling a mammogram in addition to the other medical issues in my life. I picked up the phone with dread and called my breast center. I made a mammography appointment for the next week. Then, quietly, I asked the woman on the phone exactly how long it had been since my last mammogram.

Three years, she replied.

Three years. I hung up thinking that if my survivor friends ever found out, I would be drummed out of the breast cancer sorority. Well, I will do better next year, I vowed. I wouldn’t be like breast cancer survivors in the research who, with the passage of time, no longer feared recurrence and let other health concerns move to the forefront. After all, I had been faithful for 18 years, so surely I could forgive myself this one lapse in a period of time that was so busy and stressful.

But waiting in the wings was a better reminder of the value of this annual appointment.

After my mammogram the next week, I chatted with other women while waiting for the results. “Ms. LaTour,” the voice called from the door. “Here,” I said, expecting the usual phrase, “You can get dressed now,” which signaled all is well and I could dress and leave. Instead, she said, “The doctor wants to chat with you for a minute.”

“OK,” I said, really more irritated than anything. I needed to get back to work.

The radiologist took me into an exam room and began explaining my mammogram. She slid into the discussion as she would with a woman getting her first mammogram. “There are some calcifications I am concerned about,” she said finally.

“Whoa,” I stopped her. “Are you saying I need a biopsy?” She stopped, and I explained that professionally, I “do” cancer 24/7. So she skipped the intro and got to the point: I had a number of spots of calcifications and one looked “very suspicious” to her. By now I know how doctors deliver information, and when I asked her how suspicious, she said it looked like I had ductal carcinoma in situ (DCIS) and I needed a stereotactic biopsy.

I heaved a sigh of relief. DCIS, I knew, meant the cells, if they were malignant, were contained, and the chances of the cancer requiring anything other than a mastectomy were slim. This I could handle, having spent five months 21 years ago undergoing nasty chemotherapy for stage 2B breast cancer. I’m sure the radiologist was flabbergasted at my response, but all my survivor friends got it immediately.

When you have done the Big C, the little c is much less frightening.

And this time I wasn’t immobilized by fear of the unknown. I knew exactly what to do.

Within three days I had a biopsy and knew that the site showed malignant cells. Within 48 hours I had talked to my surgeon and oncologist, and made an appointment with the plastic surgeon I wanted to use for immediate reconstruction. We found a date when everyone could meet in the operating room.

On Nov. 19, Monday of Thanksgiving week, I underwent my second mastectomy — with a number of significant changes that point out how far we have come in the breast cancer community and how our fundraising to support research and advocacy has paid off.

To begin with, there was no fighting with the insurance company to pay for reconstruction. And the surgery and reconstruction techniques have moved forward dramatically. The skin-sparing mastectomy meant that the only incision on my breast was around the areola and nipple complex, which was removed. Then the surgeon, through this 2-inch hole, removed all the breast tissue and a single sentinel lymph node.

My first mastectomy left three horizontal scars on my right breast, one from the initial mastectomy that went across the middle and then two to place the eye-shaped piece of skin taken from my back during reconstruction, which occurred a year after the mastectomy. I also have a separate scar in the armpit from the axillary dissection when all the lymph nodes were taken, meaning I spent six weeks rehabilitating my arm. The vertical reconstruction scar on my back measures 8 inches.

This time, the decision to have a sentinel node biopsy despite the very low risk of lymphedema, which I have in my right arm, was made in consultation with my surgeon, who said that if we didn’t take the single node and the tissue turned out to be at all suspicious, they would then have to take all the lymph nodes and would not have the option of just taking one. I agreed.

After the surgeon had removed all the breast tissue during this surgery, the plastic surgeon took over, making a 4-inch horizontal incision in my back through which he freed the latissimus dorsi muscle from its location, leaving only the blood supply attached. He maneuvered the muscle through the underarm area and onto the chest wall, taking just enough skin to replace the areola complex. Under the muscle he placed an empty expander sack that gradually would be filled with saline to the desired size and then, probably around the end of March, removed and replaced with a silicone implant.

When you have done the Big C, the little c is much less frightening. And this time I wasn’t immobilized by fear of the unknown.

On my left breast I have no vertical scar! It was already clear, only two weeks out of surgery, that when the areola skin is tattooed and gathered to make a nipple, it will match the reconstructed breast on the right side beautifully.

Post-surgery was also very different. I always vomited in the recovery room, but this time I asked for a healthy hit of a popular anti­emetic that became available after my first cancer. I awoke in the recovery room ready for lunch. Within hours I could lift my arm above my head while I talked with a standing-room-only crowd of friends and family in my hospital room. After the first surgery, I spent weeks and weeks walking up the wall with my hand and stretching on the floor to keep scar tissue from forming.

I went home the day after surgery. My daughter, whom I feared I would never see start school 21 years ago, took off a few extra days of her Thanksgiving break from her senior year in college to come home and lovingly care for me.

I did shed tears for the loss of yet another body part, but they were really more for all the women I have known and loved who did not live long enough to benefit from the ongoing research we have all fought for — and for those diagnosed today for whom we still don’t have an answer.

But we will. We will!

As an editor of Heal or CURE and a 21-year breast cancer survivor, i was reminded with our Winter 2007 issue of the importance of what we do-when one story may have saved my life.

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