One thing that surprised me most about cancer is the amount of choices you are given when it comes to your treatment plan. Who has a lumpectomy before a double mastectomy? This girl right here is guilty as charged and very much proud of the plan me and my breast surgeon put together. Now, this specific process might not work for you and that is okay. I do encourage you to provide your medical team with all your concerns so they can come up with a plan tailored just for you. Now, I know you know this but I will say it anyway. I am not a doctor and the information below is just my experience. Please consult with your medical team regarding your individual treatment. Let’s get into it…
What is a lumpectomy?
A lumpectomy, also known as a segmented mastectomy, is a surgery to remove the cancerous tumor and surrounding healthy tissue from your breast, hence, the term clear margins. Depending on the size of your tumor, a lumpectomy can allow your breast shape and size to remain unchanged unlike a mastectomy which removes the entire breast, Based on a number of factors, breast cancer patients are usually given an option of lumpectomy OR mastectomy. In my case, we got creative and found a case for both.
Why did I choose a lumpectomy before my double mastectomy?
As I mentioned before, each person’s situation is unique. As soon as I tested positive for the BRCA mutation, I knew that a double mastectomy was the right option for me. What I needed to get clear on was reconstruction. I did so much research to find the right solution for me and settled on a DIEP flap surgery. Without getting too technical, the surgeons use fat from your own body to make breasts. You heard me. Innovation at its finest!
The next step was to understand the different factors that can affect reconstruction. Radiation was a major concern for me because over the course of treatment, it can change the elasticity of the skin and cause significant shrinkage. Since radiation usually occurs on one side of the body, breast symmetry can be compromised if you don’t have a very skilled surgeon in your corner.
I absolutely could have waited until my double mastectomy procedure to find out if radiation would be necessary but to me, that was way too late. The last thing I wanted was to wake up from my double mastectomy with news that I needed radiation on my new and expensive reconstructed breasts. These surgeries are not cheap (even with insurance) so I was open to any solution that would help support reconstruction efforts.
After chemo, the plan was to perform the lumpectomy and sentinel node biopsy to identify any cancer spread and thus, need for radiation. If there was a need for radiation because my lymph nodes contained cancer, my surgeon recommended a double mastectomy, staying flat through radiation and then having reconstruction. That is two additional major surgeries and I was already nervous about the minor lumpectomy. On the other hand, if my lymph nodes were cancer free, then the double mastectomy with immediate reconstruction (one long surgery and recovery) could go forward as planned.
So, that is why I chose lumpectomy before mastectomy. The lumpectomy gave me just enough information (mainly about radiation) to ensure reconstruction had the best possible outcome.
What scans or imaging do you need prior to surgery?
The first step is to ensure all the appropriate scans and imaging are completed. I received a mammogram and ultrasound to get an updated sense of the tumor size as well as any indication of lymph node involvement. I am happy to say that my tumor could no longer be found via imaging and my lymph nodes still looked “healthy” but what I loved about my team is that they continued to be cautious and didn’t skip any steps even though my scans looked promising.
Next, I was scheduled for magnetic seed placement where a tiny magnet was lodged right under the clip in my tumor so the surgeon could easily locate the tumor during surgery. This is done with a pretty long needle but they numb you with anesthesia prior so I felt no pain just a whole lot of pressure. This is one where I recommend you look at the screen and away from the needle. The procedure took about 15 minutes from numbing to completion. Make sure you ask for warm blankets, if they have them. You’ll want to be as cozy as possible.
Then, it was on to nuclear medicine to receive the injection of blue dye into my lymph nodes. If you can schedule the nuclear medicine injection directly after the magnetic seed placement, I highly recommend it. Given that you’ll still be numb from the anesthesia, it will help with the burning that most people complain about when the blue dye is injected. It takes less than ten seconds and I didn’t feel a thing. Oh, I almost forgot. You’ll be peeing blue or green for a day or two after this injection. You’re welcome for the heads up!
How do you prepare for lumpectomy surgery?
- No supplements, medicines, blood thinners at least 10 days prior to surgery. I am not on any medication but I wanted to note this because it could affect your surgery date if not adhered to. Please be upfront with your surgeon about what medications you are taking ahead of time.
- No eating or drinking after midnight. This was extremely difficult for me because my surgery was scheduled for 4pm and didn’t actually start until 6pm. You are allowed to have water up until 2 hours before if that is any consolation.
- Shower with anti-bacterial soap the night before and the morning of your surgery. This is the only time I will recommend Dial as something you should use on your skin. I’m a loyal Dove girl through and through. After you lather, let the suds sit on your body for 5 minutes and then rinse. We’re not playing with these germs one bit!
- No deodorants, creams or lotion. This is pretty self explanatory but I was still happy for the reminder. Pack all those smell good items away for a later date. Skin and more skin are the only requirements for this surgery.
- Keep your phone close for a call from surgery scheduling the day before. It may be different at your center, but at MD Anderson, you receive the report time and location via phone call. If you don’t get a call by 7pm, dial the number on the sheet provided. I received my call around 4pm with no issues. I do suggest you write down exactly what the scheduler tells you because you have quite enough on your mind.
- Wear comfortable clothing or pack pajamas for after surgery. They will change you back into something. Just make sure you put some thought into what you want that to be.
How long does surgery take?
Because surgery time is dependent on the state of your lymph nodes, this can vary. My surgery started at 7:00pm and by 8:30pm I was “awake”. When the surgeon removes the initial 3 to 4 lymph nodes and pathology comes back with an “all clear” report, the estimate time is approximately 1.5 hours. If pathology find cancer in any of the initial lymph nodes, the surgeon will go back in and remove a larger section of lymph nodes which extends the length of your surgery as well as your stay in the hospital.
How soon after a lumpectomy can you go home?
As mentioned above, if your lymph nodes are clear and there have been no complications from surgery, you can go home the same day. I believe I was discharged around 9:30pm. I don’t remember much but I do recall a nurse wheeling me all the way back to my hotel room (which was connected to the hospital). It is very important to note that this is not the type of surgery where you can leave the hospital on your own. They will not discharge you without a caregiver present. Thank goodness my husband was there with me because getting to our room is the last thing I remember.
My surgeon did mention that if I needed additional lymph nodes removed due to pathology’s findings, I would have to stay in the hospital overnight so maybe pack a cell phone charger just in case.
What is the recovery time after a lumpectomy?
I believe recovery time is unique not only to the patient but the type of lumpectomy surgery performed. I woke up in a light pink surgical bra stuffed with gauze. After 24 hours, I felt comfortable enough to wear a regular sports bra. My surgeon used internal stitches with dermabond glue which I appreciated because little to no maintenance is #lifegoals. The next day I showered carefully and pat the incision dry with a clean towel. I was a bit sore but not in enough pain to require any pain medication. Acetominophen with codeine and tramadol were prescribed but luckily, I was not in any pain. I do remember being told that pain medication can affect your bowel movements and cause constipation. Just putting that out there so you are aware of the side effects.
Around 2 to 3 days later as healing progressed, I felt tightening close to the incision area. I also developed some numbness and swelling within a 6 inch radius of my incision. Even though I was warned of that side effect, nothing really prepares you for a numb underarm. It’s been over a week now and my underarm is still swollen and numb. I’m not quite sure how long it will last. Apply deodorant feels so weird…
To ensure range of motion was not affected, I did my simple physical therapy exercises every day which looked like a lazy man’s yoga. It took less than 3 minutes but I believe the light stretching helped significantly. Make sure you discuss with your medical team what exercises, if any, are appropriate for you.
Once the swelling goes down, I will try to remember to update this post so you have a better idea of how long “recovery” can take. I do have an appointment scheduled with my breast surgeon 2 weeks post surgery so any restrictions on lifting or exercising may be lifted after that.
How long does it take to get your results?
Let me explain what results mean in this context. This entire procedure is to understand if there are any traces of cancer still remaining in your body. In my case, I did chemo first so the lumpectomy surgery checks my tumor’s response to chemo. With many designations, there are three letters that are associated with receiving that honor. This is no different. Pathological Complete Response (or pCR) is defined as the absence of invasive cancer in the breast and lymph nodes after treatment. From the time I was diagnosed with cancer, it’s all I wanted to hear.
My surgeon told me to expect pathology results within 5 to 7 days after surgery. It was eight days after my lumpectomy and I was literally steps away from boarding an airplane home. On the other end of the phone was my breast surgeon, who told me pathology results were in. Her exact words were “the chemo melted my tumor away” and there was no cancer found in my lymph nodes. Your girl was cancer free, y’all. I still had a plane to board. At least I was able to make a quick video to capture my reaction before take-off. I hugged my husband and thanked God for His favor with tears in my eyes. In that moment, all I could decipher was gratitude and I am still grateful today…
