Yesterday I met with the radiation oncologist. It was quite a long visit with an exam that included testing my strength and reflexes as well as palpating the breast tissue (he was pleased with everything) and a long conversation about next steps. I'll try to cover all the highlights. It didn't go quite as well as I'd hoped.
Although the surgery decision is up to the surgeon and me, he recommended I go with a mastectomy of the right breast. He said I'm a high risk for local (as in, the same area rather than the other breast or another area) recurrence, so we need to do everything possible to make sure that doesn't happen. As much as I would have loved to go with the less invasive surgery, I am totally on board with doing everything possible to keep the cancer from coming back. So, I will go with that recommendation.
He also said I might want to skip the tissue extender (which would A. give me some symmetry until reconstruction and B. get the area ready for reconstruction as far as room goes) because he suspects the surgeon will take some of my pectoral muscle since it was affected by the tumor and there could be increased risk of complications with the TE. Also, he suggested waiting a whole year after radiation to get reconstruction to make sure I'm really cleared of cancer. So, that means wearing a prosthetic so I don't walk around with one boob. It's a bummer, but there are worse things (knock on wood).
Because of my risk and there's some skin involvement (I mentioned the red patch of skin early on--it's reduced greatly but still there), he will treat me more aggressively than most people. I will have 25 treatments to the whole area (to capture the involved lymph nodes next to my breast bone) and 5-8 more (probably 8) to just the part where the tumor was. He said I will sunburn and blister...and if I don't blister, he will keep blasting me until I do, because that needs to happen in order to ensure the skin is thoroughly treated. Joy. On the bright side of that, the skin where my breast will no longer be won't hurt, because it'll be numb. The worst part will be on my armpit, since there will probably still be sensation, and the skin-on-skin contact will be uncomfortable.
I'll have permanent scar tissue on my lungs that will show up on scans, but it shouldn't affect me too much. There is little risk to my heart since we're only targeting the right side. There will also be some scarring of the chest wall, which could affect reconstruction.
Radiation generally starts 4-6 weeks after surgery, depending on how long it takes me to recover. I need to be able to put my arm above my head, and the probably dissection or removal of the lymph node in my armpit may make that difficult. There won't be any restrictions on my diet or activities other than no sitting in hot tubs or nude sunbathing--no problem. My energy will probably be affected, especially in the last 2-3 weeks. That's nothing new, but I hope it recovers a bit before radiation starts so I have a chance to feel normal for a little while, at least, and get some exercise.
That's everything that I remember and that we took notes on. Next up, meet with the surgeon on Tuesday. Last chemo on Wednesday.
Michael is feeling better, although not 100% and we're giving it another day before we have contact. His son is over it already. So far, knock on wood, I am asymptomatic so maybe our precautions worked.
Mentally, I'm fine with all the news even if it wasn't what I wanted to hear, because I was already resigned to it anyway. Mostly I'm feeling lonely and pissy about being quarantined. Just another day or so!