Second Surgical Consult

Although I had a few telephone calls with the surgeon since the initial consult, I decided to go see my surgeon in person again to discuss my surgical plan.  I wasn't entirely sure what was happening.

Since biopsy of the two new masses could potentially be inconclusive, it was suggested that they would just remove them along with the cancer that had already been identified.  I agreed.  Even if they were benign, I've had a few cysts elsewhere in the past that got infected and needed surgical removal.  I don't want any surgeon not specializing in breasts to have to do any sort of emergency surgery if something like that were to happen in my breast.   

What I couldn't agree on was the lymph node removal under the arms on the right.  Standard practice for lumpectomy (and I think mastectomy) is to identify the sentinel nodes (the first nodes in the lymphatic system that the tumor is likely to drain into) and remove them so that they can determine if the cancer cells have spread there. If so, the treatment plan could change. Typically there's 1 to 3 sentinel nodes, but there could be more. The surgeon couldn't tell me exactly how many she was going to take. I was very concerned about the lymph node removal because of the increased risk of getting lymphedema.  I had grand plans in my life and didn't want to worry about every animal scratch or bug bite on my arm causing lymphedema. Just like I didn't want radiation or meds, I didn't want lymph node removal.  I was going for the minimally necessary approach.  There was also the chance that if the left mass turned out to be cancer, I would have to go back in for lymph node biopsy on that side.  I figured if the left mass was cancer I'll go back for lymph node biopsy on both sides.  The doctor wasn't thrilled, but she agreed not to remove it during this surgery.  However, if my oncotype came back high (20+), she said I should come back for the biopsy regardless of what's going on in my left breast.  I didn't know what an oncotype was but I said ok. 

So, the final plan was to remove 4 masses:

• The cancer (R)
• The suspected satellite mass near cancer (R)
• The mass behind the nipple (R)
• The mass near chest wall (L)