Thursday, December 19, 2013

On Being That Girl


Six months ago, upon waking up from a righteous mix of Propofol and Versed, I wanted to be THAT girl.
The girl who conquers breast cancer mind, body and spirit and moves on with her life stronger than ever before.

I am the girl who showed up to the Kaiser Permanente Survivor event five days post-op and took the mic to speak on profound gratitude.

I am the girl who walked a 10K a week after a mastectomy.

I am the girl who tent camped and hiked in Sequoia National Park three and a half weeks post-op.

I am the girl who rocked a bikini stuffed with a prosthetic breast on the shores of the Pacific Ocean two months post-op.

I am the girl who continues to show up at the breast cancer support group, decades younger than most of the women, with a can-do attitude and a positive spirit.

And I desperately wanted to be the girl who practiced mindful gratitude, overlooked the loss of her left breast, thanked her community six months after diagnosis and then closed the book on cancer.

But I’m not that girl.

Being lopsided makes me sad. Being lopsided makes me frustrated. Being lopsided makes me think about – and see the impact of – cancer every day. In the past six months, I have realized that while I still believe body perfection is ridiculous and impossible, body symmetry is important to me.

So I’m having surgery.

Women seeking reconstructive surgery post-mastectomy have a wealth of choices – IF they have enough of their own tissue to move around:

Deep Inferior Epigastric Artery Perforator (DIEP) Flap
Transverse Rectus Abdominis Myocutaneous (TRAM) Flap
Transverse Upper Gracilis (TUG) Flap
Superior Gluteal Artery Perforator (SGAP) Flap
Superficial Inferior Epigastric Artery (SIEA) Flap 

All of the above procedures use the patient’s own tissue and relocate it to the breast area.

My options were limited due to my body shape and size.

I can have implants or I can have implants.

So, on January 17th, one year to the day of my mom’s breast cancer diagnosis, and seven months to the day after my first mastectomy, I will again be wheeled into the operating room.

Things will be different for sure. I will be having a right side skin sparing mastectomy and double reconstruction but I will not be having a sentinel node biopsy and I will not wake fearing what they found in my breast tissue. My right side mastectomy is prophylactic and was decided upon after much personal thought and extensive conference with my oncologist, breast surgeon, plastic surgeon and family.

And then it came down to a math problem of sorts.

I am uneven. I want to be even. 

If my plastic surgeon reconstructs a breast on the left side, it will be the pert breast of a 20-year old. My right side breast is 40 years old and nursed two children. I would still not be even.

My plastic surgeon sees no problem with that and could add a small implant to the right side to even me up. The rest of my team sees a slight problem with that right side bump since even a small implant in the right breast could potentially impede the accuracy of any future mammograms. In math, we'd call that a variable. And then we'd solve for it.

As a reminder, my first mammogram caught only calcifications. My excisional biopsy found diffuse DCIS and my two invasive tumors were only found by the pathologist who chopped up my breast tissue post-mastectomy. In other words, dense breast tissue has not served me well in the mammography space and adding more padding certainly won’t help anyone get a clean view of what's going on in there.

Nor will it help with my persistent anxiety around ‘what-if’.

Am I making an emotional decision? Yes. Will it forever protect me from a recurrence of breast cancer or a metastasis? No. Am I making an informed emotional decision that is right for me? Yes. 

Because I am that kind of girl.

In less than a month, I will wake up lopsided with tissue expanders in place under my chest wall. My breasts will never look normal (something about that enormous scar that starts low, crosses the left side of my chest and ends high under my armpit). I will begin a process of regular 'fills' until my skin (especially on the left side) stretches enough to accommodate a B cup again. Then I will have exchange surgery to trade my expanders for implants.

And then will it be over? Will I then be able to close the door on cancer and move on? I don't think it happens exactly like that for anyone. I don't think you 'get over' cancer, I think you incorporate the fear and the anxiety and the gratitude for all that is good in your life into your mindset. As much as I'd like to close the book on the last six months or, better yet, rewrite them, breast cancer is part of my story. 

But it's not the only part and it sure is hell isn't the ending.

I will most likely always suffer from a bit of anxiety around oncology follow-ups and random body pains but I will be on the path to feeling whole again. I will be making a decision and taking control of my own body as much as any of us are able.

I am THAT girl.