I finished chemo and sat in denial of the next chapter for as long as I could. I traveled to Austin for my friends 40th. I did a long weekend in NYC with the guy. A girls retreat to Orcas Island to celebrate another friends 40th. I stayed off my “cancerstagram” aka the account where I follow other women battling breast cancer. I avoided my fb groups. I didn’t google a thing.

It was great until it became time to focus on the next step. I had another MRI, mammogram, and ultrasound to see how good old Uncle Joey is progressing. The good news? Chemo kicked his fucking ass. I’ve been told this is rare for my type of cancer. I am 98% ER and PR positive. Allred 8/8 on both. HER2 negative. Typically my type of cancer doesn’t respond well to chemo. Well then. Glad I was told this AFTER chemo. grumble. I got lucky for once in this journey but damnit I wish health care providers would be totally transparent up front.

My cancer measurements were 82 x 51 x 30 mm in the beginning. Translation? a SHIT TON of cancer. DCIS and two tumors. One was 22 x 20MM and the other was around 19mm Now? The smaller tumor is gone. The DCIS is now 43 x 14 x 15 mm. My big tumor is now 14 x 12. A T1 tumor. A tiny little nugget. All my previous scan reports screamed “MULTIPLE NODE INVOLVEMENT”- luckily my surgeon has come to terms with my need for intensive clarification (sorry, not sorry). On my last appointment I discussed these results with her since “multiple” isn’t a number and I NEED ALL THE DAMN DATA I can get so I can obsessively google about it at 1am. She was nice enough to go through my scans and clarify that at the start two nodes were are obviously cancerous and 2 looked suspicious. Oh ok, so 2-4 nodes in my first auxiliary. Jesus H. Christ, this is the low end of node involvement and doctors are fucking hypebeasts.

I have no clue how I was ever told I was stage 3C.  Did y’all even look at the data? Because I did and hey, guess what? My repeated calculations and breast cancer staging app all say stage 2A. After chemo my nodes look totally clear. If this is the case I am now at pathological stage 1A. I like the way that sounds.

The best part of having selected neoadjuvant chemo? I now qualify for nipple sparing. A small little incision will go under my breast on Monday. The tissue will be removed and I’ll be sewn back up. When reconstructed it looks pretty damn passable. I’m THRILLED about this. Because I had chemo prior to surgery, I will have a sentential node biopsy. They will remove the 3-6 nodes that light up in mapping. Those will be sent to pathology while I am in the operating room. The mapping procedure is terrifying – I guess its a large needle inserted in my (overly sensitive) nipple. I’m going to need heavy sedation.

Now this brings us to what I’ve been struggling with the past two weeks. Let’s say there is still cancer in those nodes. At this point I’d be subject to a Auxiliary lymph dissection. Where they remove ALL of my nodes in my arm. Not only is this a more intense recovery but it also increases my risk of lymphedema. Lymphedema is not only hideous but would interfere with my quality of life. I would have a hard time flying. yoga. lifting. I’d have to avoid hot tubs and saunas. no backpacking. HARD PASS.

Now there is a clinical study being ran by SCCA. I would be randomized in the OR. This is my only chance of not getting all of my nodes removed if the sentinel nodes are positive. In the event they draw my name, I would keep my nodes and instead have them radiated.

Sounds great right? However, there is no data. They don’t yet know that radiation is as effective at preventing reoccurrence as a full dissection. They THINK it is, but they don’t KNOW. That’s what the study is for.

Study details: https://clinicaltrials.gov/ct2/show/NCT01901094

I’ve struggled with the decision while jumping through all the hoops like I would be in the study. Meetings with study coordinators. 101 questions for my surgeon, more tests and measurements. More appointments. More time at SCCA.

At this point I think I’ve landed on yes, I will participate. A big thank you to everyone who has let me pick their brain about this. If you see any reason I should NOT participate, please do let me know asap.

Now comes the terrifying part. Surgery. T-minus one more day with my boobs. I’ve been walking around on the verge of a total breakdown for the past couple of weeks – props to everyone who has put up with me -you know who you are <3. I know the breast is not a necessary body part but god damnit I have always loved mine. I’ve always thought they looked great – even after childbirth and breastfeeding. To be totally honest, (close your eyes fam) they are an important part of my satisfaction behind closed doors. I’m crushed to lose one. This is why I am not letting them take the other. Dear cancer, you can only have half my femininity. Ok, 3/4 since you got the hair and lashes too. Asshole.

As the daughter of a recovery room nurse, I am scared of general anesthesia. I had a “light” general when my impacted wisdom teeth were removed. I had a full general for my ACL when I was 28 and too young and fearless to be afraid of it. I’m scared of stitches, bandages, blood and the drains I’ll have attached to my body for weeks. I’m scared of showering and looking down to see my mutilated breast. I can’t wrap my head around not driving and not reaching above my head. I’m a stomach sleeper and that is out. Another 8 weeks out of the gym.

This is mostly a psychological battle I’m facing but I can’t deny the physical aspects are going to be hard as well. This makes chemo look like a walk in the park. I’m extremely grateful that my little sister (also a nurse!) is coming up to help me for 5 days after my surgery.

Chapter 3 now comes with chapter 3.5 – my second surgery and yet another trip under general anesthesia. Another recovery. Due to the size of my breasts being at the “top of the preferred size” for nipple sparing, they want to stagger my surgery. Typically this helps to ensure the nipple has good blood supply and I will have less risk of losing it due to necrosis. (fucking a, necrosis. I can’t even begin to think about that)

I will have the mastectomy first and then come back in two weeks later for the tissue expander placement. I’ll finalize reconstruction sometime towards the end of 2019 after radiation.

I’d like a time machine to whisk me away to April.