Wednesday 5th January 2022. The date of my lumpectomy.
Nil by mouth since midnight, very little sleep and a very early start! As instructed I had a shower that morning and was advised to drink 300 ml of clear fluids at 7.00 am.
Just as a reminder, this is the summary of my situation so far which was provided in a letter to my GP:
“Lisa is currently asymptomatic and was recalled on the screening programme with a 12 mm cluster of microcalcifications medially in the left breast at around the 3 o’clock position which was biopsied under stereotactic guidance and a marker coil was in put in place. The biopsy has confirmed High Grade DCIS (Ductal Carcinoma in Situ), ER 8/8 and PR 6/8.
There was also a separate cluster of calcifications measuring about 9 mm which was deep to the left nipple and the radiologists were unable to biopsy this as it was too superficial and on review they felt that these were unlikely to be of clinical significance and therefore felt that they could be left alone and not targeted. This has been discussed at the Screening unit’s MDT meeting in Brighton and also twice at the Conquest MDT meeting. We are therefore concentrating on treating the 12 mm area of medial calcifications. I have explained to Lisa about the assessment of margins on the surgical specimen and if further surgery is required it will be discussed in the follow-up post-operative clinic after appropriate MDT review.
For the present we have discussed right wire-guided wide local excision for the high-grade DCIS. This may be followed by breast radiotherapy and endocrine therapy.”
We arrived at Gardner Ward which is a 28-bedded surgical ward for male and female patients. The surgery covers abdominal, breast and general surgery and the unit also benefits from Enhanced Recovery After Surgery (ERAS), which aims to support early discharge of patients. Technically a day surgery unit. My arrival time was 7.30 am but my husband wasn’t allowed beyond the main ward doors so I went in alone.
There were a couple of other ladies admitted the same morning, both for breast surgery. We didn’t chat, I think we were all too nervous. The first thing I was asked to do on arrival was a urine specimen. It was to check I wasn’t pregnant! Now that would have been an added complication, in more ways than one! I was given a hospital gown to put on, measured for surgical stockings and given an identification tag. Then followed the usual preparations, a lot of questions, first from a nurse then later a visit from the anaesthetist. He seemed very young (I know, it’s actually that at I am now old!) and was very nice. We discussed my previous reactions to general anaesthetic, in particular the nausea and extreme drowsiness post-op. He reassured me that he would give me sufficient anti-sickness medication with the anaesthetic so hopefully I would have a much better experience this time.
Most of that day was a lot of waiting around. The older lady of the two others went down first for her surgery. I overheard her saying that this was her second mastectomy, the first being almost thirty years previously. It’s hard not to overhear the conversations on a quiet ward and the poor lady had previously had a hip replacement, a knee replacement and obviously breast cancer. What an absolute warrior. She gave me added inspiration for what was to come, both in the short term and potentially the longer term too.
At around 8.45 am I was taken down to the radiology department for the wire incision. I put on my long fleecy dressing gown and slippers and was collected by a porter with a wheelchair. I was then wheeled down to the department which is situated on the same level as the reception and coffee shop area. I can’t lie, I was rather mortified to be wheeled through such a public area in my gown and groovy stockings! It was also quite chilly so I was glad that my snuggly dressing gown wasn’t over the top! I was then left by the porter in a very stark area of the department, away from the general waiting room, for quite a long time. I wondered if I’d been forgotten but eventually I was taken in and was allowed to walk to the ultrasound room.
The process is to place a fine wire in the tumour to guide the surgeon to the lesion during the operation. This technique is called a Wire Guided Localisation. An ultrasound is performed and used as a guide to placing the wire. Although the placing of the fine wire takes seconds, the whole procedure takes about half an hour. The wire is coiled flat against the skin and secured firmly and a dressing placed over the top. By carefully tracing along the guide wire, the surgeon removes the wire and a piece of breast tissue. This can limit the surgical approach, and impact the cosmetic result.
The procedure was carried out by the same sonographer that I had met a few days earlier. He was equally gentle and explained that it is a very delicate and tricky procedure and they have to be very precise, hence the time it takes to get it exactly right, at the same time thanking me for my patience! Once the wire was inserted I had to have a mammogram to check they were satisfied with the placement of the wire. A lovely nurse performed the mammogram which was just through an interconnecting door while the sonographer looked at the images on a computer in the same room. Once satisfied it was all good, a porter was called to collect me. I was advised that I would have to be taken again by wheelchair back to the ward as they couldn’t risk anyone bumping into me and dislodging the wire. The wire was protruding from my breast with two v-shaped ends sticking up in the air around my neck area. I was advised to slightly restrict my movements while waiting for my operation. I think it’s important to say that this was not a painful experience, just a bit uncomfortable.
I then spent almost six hours just waiting. I sat in the chair rather than lie on the bed and just read my book and played games on my phone. I had a mask on and, at one point, I was coughing. The nurse asked if I was ok and I said that I was unbearably thirsty. She said I could try swilling some water but couldn’t swallow it! I didn’t risk it, I mean how hard would it be to not drink the water?! She did say though that I could remove my mask while I was just sitting in the bay. Shame I wasn’t told that hours earlier when I was sitting there with a mouth like one of Gandhi’s sandals!
I also kept forgetting about the wire and a couple of times I leaned down to retrieve something from my bag and panicked that I might have moved it! I spoke to a nurse and she said it would be fine and some people even have them inserted the day before surgery! Phew!
The Sister on the ward apologised to me for the long wait. She said if they’d known it was going to be so late she would have offered me some sips of water much earlier but it was too late now and she said they would be coming to collect me very soon.
Despite the theatre being just a few metres away on the other side of the corridor I had to be taken in a wheelchair again to protect the wire. The theatre staff were very kind and chatted to me while getting me prepared. The operation took about two hours and I was back on the ward by about 6.45 pm. I was so happy that I didn’t feel at all sick and not too groggy either. It didn’t take me long to be well enough to be discharged.
A specialist breast nurse spent some time with me explaining how important the post-surgery exercises were (more leaflets!) and gifted me a lovely heart-shaped cushion to help me get comfortable at night. She advised that I should wear my post-surgery bras and the surgical stockings for 23 hours a day for two weeks. She also gave me advice about showering.
I was given information about pain relief and also that I should make an appointment with my GP surgery for a nurse to remove my dressing. The dressing was fairly modest, basically a large plaster! The surgery was performed by cutting around the areola of my nipple so it was all very neat and aesthetically pleasing. It was the same as my right breast after I had the microdochetomy in 2008 and the scarring is very minimal, eventually just a faint white line that’s barely visible. However, initially I didn’t know what it was going to look like as it was covered up for two weeks.
Home by about 10.00 pm ready to start my recovery. For now anyway….
“I learned that courage was not the absence of fear, but the triumph over it. The brave man is not he who does not feel afraid, but he who conquers that fear” – Nelson Mandela
Hoping for a Happy Ever After 