Two boobs, or not two boobs: that is the question

Last night, just after we got the kids settled in their chairs on the screened in porch for dinner (a daily miracle), the phone rang.  The dreaded shiver of cancer-fear ran down my spine.  I gathered myself as I read "DCFI" on the caller ID, and answered.  Dr. Bunnell had the results of the "FISH" testing (I'm pretty sure I'm spelling that wrong, but that's how you say it, and I know it has to do with a very detailed genetic breakdown that uses something "flourescent").   I had been dreading this call, perhaps like no other, because I thought (rightly or wrongly) that armed with a clearer understanding of the type of cancer I have, he could tell me that for my type, they have no cure.  Thank goodness, that is not how the conversation went.

My cancer is, for sure, HER2+.  Dr. Bunnell says this changes things.  I will get chemotherapy and for a year after that, I will also receive an injectable drug called herceptin.  Again, I'm not Googling it, but a good friend emailed me to say I am spelling it right.  Dr. Bunnell says herceptin is the biggest breakthrough in cancer treatment since the introduction of chemotherapy.  He started to get into biology, and I could tell, it wasn't going to good places.  I stopped him and explained a bit about myself, that I only just learned.  I told him that I don't want to understand what's happening in my body, what's failing, and what we're trying to reverse.  I don't want to know the herceptin works for some percentage of women, because I will just live in fear of being on the wrong side of that statistic.  All I want to know is that this drug can save me and that I can beat this.  "You can beat this," he said.  But he qualified it a bit -- "The overwhelming odds are that you will beat this.  If I was a betting man, I'd go go Vegas and bet on you and I don't bet money I think I'll lose."  My legs still shiver as I write this.  I don't want to be gambling with my life.  But that's the deck I was dealt, and with all the other cards I got along with this one, I'll take it.  

Now at least I have a focus -- I need the surgery to go well, the chemo to work, and the herceptin to kick the shit out of whatever it's supposed to kick the shit out of.  Naturally, the realization came over me -- will I know in a year if I will live or I will die?  I don't really know the answer to that.  But, as weak and frustrated and bummed out I may feel right now, I know that the fighter in me is gearing up for the fight of her life and I need to stay focused on the belief that I will beat this.  

Needless to say, I wasn't really hungry after the phone call.  I know I need to defer to the doctor's schedule, but calling right before dinner is killing my appetite, and it's hard enough to eat these days.  And I've never been one to skip a meal.  

Of course, you all clicked on this post wanting to hear about boobs, not about herceptin so let's return to the question at hand -- Two boobs or not two boobs?  

As you know, before Dr. Bunnell's call last night, I had decided on reconstruction following the double boob removal.  For some reason, last night's conversation changed something for me.  It got me wondering if I should skip reconstruction altogether (at least for now) and focus solely on getting rid of this cancer.  Even when I talked to the insurance company lady yesterday (a kind nurse from their breast program who called to tell me what will be covered throughout my treatment (including a $500 wig!)), she explained that much of the pain post-surgery will be due to the reconstruction.  Should I preserve all my strength for something life-saving rather than something cosmetic?  Could the reconstruction complicate something, give me an infection that will divert my body from a more important task at hand?  Could it delay the chemo (and therefore the herceptin)?  Are we even talking such marginal differences?  As I hope you already know, I never claim that this blog has any sort of medical advice.  It just contains my thoughts and my questions, and all of the sudden I have more of the latter.  So I will call Dr. Bunnell and Dr. Chun at some point in the next few weeks to get a few of these answers.  I will also reach out to a few people that I know how been through a mastectomy and reconstruction and see if my new doubts are total bunk.  

I'm going a bit out of order here, because I really owe you a post about my plastic surgery consult for all of this to make more sense.  You already know my feelings on Dr. Chun (that she's fabulous), but I haven't yet covered the nuts and bolts of how she'll nut and bolt boobs onto my chest.  So basically, there are three options.  Let's call the first one, "Hollywood," cause I'm pretty sure it's the route Snooki went / will go / I can't keep track.  This is the implant route.  I'm probably getting some of this wrong, but the way I understand it, after the mastectomies, Dr. Chun would insert a "tissue expander" between my pectoral muscle and my original skin.  There would be drains coming out of there and I must admit, the idea of liquids "draining" out of my chest for two weeks post-surgery is less than lovely.  Dr. Chun would sew everything up and I would return, weekly, so she can expand the space in which the implant will ultimately go.  (By the way, no Dolly Parton in my future -- I've come to hate boobs and am going with a good ole "A" on this one.  I've always liked getting "A's.")

Dr. Chun explained the implant choices -- silicone or saline, fun stuff.  Advantages to each?  Well, if the saline one pops, I'll just deflate.  Awesome.  If the silicone one pops, it's not great, and I won't really know (until a yearly scan when they check up on it).  Does this mean every time I'm playing with my kids on our bed in the morning and I get kicked in the boob, I'm going to wonder if it's popped?  The fun never ends with breast cancer, huh?  Oh, and, the implants only last about 10 years.  I would hope by then, however, they've got something more durable.  

I will call Dr. Chun's second option, "Patchwork," because essentially it involves building boobs out of other parts of the body.  (Dr. Chun called this option "flaps.")  To my own shock (because I've got a pretty quality size c-section pouch on my belly) Dr. Chun said I didn't have enough fat to build two breasts.  I told her we were going on vacation and I could easily gain 15 pounds in 2-3 weeks but she said that wouldn't be good for my health.  It'd be fun though -- like I was Renee Zellweger preparing for Bridget Jones' Diary.  Only I already weigh 20 pounds more than Renee's "fat" target weight.  Gotta love Hollywood.  Anyways, this option really sounded awful -- cutting out parts of the back or the abdomen to sew them onto my front.  She also mentioned a lot about rearranging muscles, at one point describing some process that included wrapping a muscle from my back around to my front, or something like that.  I was confused and in the end, I think I'd like to look down and see something fake rather than something that had previously been on my back.  Dr. Chun agreed Patchwork wasn't for me. 

When Dr. Chun began to describe the third approach that was, in her words, even more complicated, I stopped her.  I've always liked to keep things simple and I didn't think this option would prove fruitful.  (Apologies, I don't even remember the name.)   

Then, in came the implants for us to toss around to each other.  Two weeks ago, I'd never dreamed that I'd be squeezing a saline implant in one hand and a silicone one in another, and I sure as hell never dreamed I'd be writing about it.  But here I was, secretly trying to pop the silicone implant so I could remember its strength that first time I got hit in the fake boob.  Luckily, it didn't budge.  

Poor Brian did so well through this whole experience.  He's a private guy about regular things, never mind about his wife's boobs, but cancer changes everything and all of the sudden, juggling breast implants and asking clinical questions focused on my well-being had become the norm.  Hopefully, when I'm well, his friends will give him a hard time about this.  But for now, he was just helping me along this hell-of-a-journey. 

Next came my favorite part of the appointment.  Dr. Chun explained that she was participating in a clinical trial of a new product that would fill the breast with air rather than saline or silicone.  The advantages were that the patient would not have to come into the doctor's office to "build up" the implant -- a simple remote control at home could do the trick.  Brian and I let out a good laugh almost simultaneously, and declined this option.  We later confirmed with each other in the parking lot that we had had the same thought -- Annabel loves remote controls.  We both envisioned a morning where Brian let me sleep late.  He and Annabel would be downstairs and Annabel would find the "grow mommy's boob" remote.  She'd try to turn on the ceiling fan as my right boob grew into a DDD.  No thanks.  I'll leave the clinical trial to women without kids with remote control obsessions.   

So here I am, HER2+, scared, thankful, hopeful, and wondering, two boobs or not two boobs?  My family and I head to Falmouth today for a week's vacation we planned months ago.  I guess I'll ponder this question as I sit by the pool and as I throw my kids around in the water (and count how many times they accidentally hit my boobs).  I'll ponder this question and many others.  And I'll soak up that sun and that time with my family like it's the most treasured thing in the entire universe.  Because it is.  No matter how many more chances I get at it.