On the afternoon of Wednesday 21st March 2022 I had my next clinic appointment with the breast consultant. The purpose of the appointment was to be given the results of the sentinel lymph node biopsy and also to discuss the next stage of my treatment.
I was relieved to have confirmation that the nodes were clear of cancer cells which gave me a level of reassurance that the cancer had been contained to my breast. The consultant also checked my wound and was satisfied that all was healing well.
We then discussed the next step and, rather disappointingly, my consultant seemed to have no memory at that time of my request to consider a double mastectomy. She claimed not to have received this information despite informing me on the hospital ward a couple of weeks earlier that she had received the email. I did have a moment of brief panic at this point but I can only imagine the amount of patients these consultants must see and I knew that she was also covering a colleague’s clinic due to long term sickness so it’s not surprising she hadn’t recalled this one detail. She was more than happy to discuss it anyway.
At first I thought she wasn’t going to support me as she gave me a lot of facts about this type of surgery. She said there are a lot of protocols around what might be considered a more drastic option because in the past some surgeons have been rather “Gung Ho” about performing double mastectomies that may have been deemed unnecessary by other specialists. Hospitals are monitored very closely for their numbers in terms of this type of surgery, although she added that the Conquest had never been highlighted as culpable in this respect as they do very few operations of this kind at the hospital. For this reason, the request could not come from her ‘as a surgeon’. However, she said that as I had expressed my concerns to my Macmillan nurse, she would be able to speak on my behalf at the multi-disciplinary team (MDT) meeting.
She then went on to discuss my individual situation and considered all the concerns I had. This of course included my family history and my own earlier issues – i.e. a lumpectomy aged 20 on the left side and total duct excision (microdochectomy) aged 40 on the right side. She did stress that the risk of the cancer returning in my other breast was not considered to be high. Whilst I acknowledged and understood this, my mum’s cancer had returned 15 years after her primary breast cancer so this was obviously something I couldn’t help worrying about. In addition to alleviating those fears, she also said that aesthetically it was likely to give me a good symmetrical result. I did feel, in the end, that she supported my reasons and was happy for the nurse to go ahead with the request.
It would now be down to the team as to whether they agreed with the decision. In the meantime, my consultant would send her referral to the Queen Victoria Hospital in East Grinstead, West Sussex, a hospital specialising in reconstructive surgery.
This was the start of another ‘limbo’ period, mainly due to a series of unexpected events which I will come to later on. In the meantime, I left the hospital with mixed feelings. On spreading the news that my lymph nodes were clear of cancer I received a lot of congratulations from pleased and relieved well-wishers. However, I found it really hard to ‘punch the air’ and this may be hard for some people to understand. It is also a bit unusual for me as I always try to be positive and remain optimistic. So I will tell you why I wasn’t jumping up and down for joy at this point. Of course it was very good news but I was in exactly the same position as I was before the surgery. Removing the nodes was only an extra precaution because they had actually already shown up clear on a previous scan. The good news is that my situation hadn’t got any worse which is obviously great but I still had the same daunting journey ahead of me as before. I felt guilty for not being more grateful but when you’re in a constant state of anxiety it’s difficult to overcome the overwhelming sense of fear and dread for what’s ahead. I think I had done well to remain strong but I also think I had a right to be a bit scared.
“Sometimes the strength within you is not a big fiery flame for all to see, it is just a tiny spark that whispers ever so softly “You got this. Keep going.”
I received a call from my Macmillan nurse just over a week later following their weekly meeting. She gave me the good news that the team had agreed to my request for a double mastectomy. I also received a copy of the referral to the Queen Victoria Hospital.
“Dear Plastic Surgeon colleague,
I would be grateful if this lady could receive an appointment for plastic surgery assessment for bilateral mastectomy and immediate DIEP flap reconstruction please.
Mrs Hammond has undergone initially a left wire-guided wide local excision of the left breast on 5th January 2022 for what was thought to be screen detected high-grade DCIS measuring 12 mm. However, on definitive histology, a larger area of 37 mm of intermediate and high-grade DCIS was confirmed with a 4 mm invasive component which is ER positive 7/8 and Her-2 receptor positive. There was no vascular invasion. The DCIS is also oestrogen receptor positive 8/8. Unfortunately due to the size of the DCIS, the lateral margin was involved and the inferior margin was also close at 0.5 mm and the medial margin was only 0.8 mm. The MDT therefore advised left completion mastectomy and sentinel node biopsy followed by anti-HER2 treatment and chemotherapy.
Mrs Hammond has been considering her reconstruction options and in the meantime has undergone left-sided sentinel node biopsy which has revealed 2 normal sentinel lymph nodes which is reassuring. She has decided to proceed with left mastectomy and immediate reconstruction using autologous flap reconstruction e.g. DIEP flaps, as she does not wish to have silicone implants.
However, she has also requested contralateral i.e. right-sided risk reducing mastectomy. We have gone through the contralateral mastectomy protocol and Mrs Hammond understands that the risk of contralateral carcinoma is low and that contralateral mastectomy will not affect prognosis of the original carcinoma. However, in view of her family history, although she has not undergone genetic testing, she would prefer to have bilateral mastectomy to alleviate anxiety. She is supported by the breast CNS team and ‘X’ the breast CNS who met Mrs Hammond in clinic today, will take this request to the breast MDT meeting this week to discuss it with the multidisciplinary team and to ratify that decision.
On the left side which is the side of the DCIS, we would advise nipple-excising mastectomy. However on the right side Mrs Hammond would be eligible for nipple-sparing mastectomy if deemed suitable by the plastic surgery team.”
Next step would be meeting the plastic surgeon which, as had been explained to me, may not be for a few weeks. I just managed to return to work for one week before the Easter holidays. It was a way of easing back gently after two surgeries and quite a considerable period of absence. A little bit of normality in what had been an otherwise incongruous and bewildering existence.
“I am a warrior. Not because I always win but because I will always fight”
Hoping for a Happy Ever After 