day 191 – modified radical mastectomy for male breast cancer

If chemo is a journey, then surgery is day out: chemo takes a long time, has many twists, turns and delays, and at times seems never to end; in contrast, surgery is for sure a day when you are out of it, and over before you know it. But that’s as far as it goes. After all, most journey’s are fun, or at least interesting and broadening, and most days out equally so. Neither chemo nor a mastectomy can be described that way. Today is my day out!

I haven’t written much these past 4-and-a-half weeks since I got my last chemo dose. As usual the chemo was on Wednesday, and for the first time I took Thursday and Friday off completely. Then I was back at work for two weeks, which now seem a bit of a blur. Things at work are extremely busy at the moment – we are at the peak of activity with some of the work that varies through the academic year, and our new leadership is bringing new programs and ideas online, which is work that is layered on top of the daily transactions that need to happen. Sometimes it is a challenge for me to keep my activity level at where it was 6 months ago.

Then we had spring break which I spent at home with the kids. We had fun at the rodeo, went to the movies and played with our new puppy in the back yard and played board and video games. It was just great, and a real break.

Then last week another busy week in the office, where we tried to get every last meeting in before I go off for my surgery.

The chemo recovery this time was for sure slower than before, and even now I feel tired, and often beat the kids to bed, or at least to sleep (on the couch, with the puppy). Most of the other side effects have receded. My feet are still a little numb, and the taste is not quite normal, but its already much better than before. Most reluctant of all are the old follicles, with little sign that they are willing to grow some hair. Sure saves time when you only have to shave once a week 🙂

The dominant feeling this past month was just the joy of being done with chemo. I would catch myself with a grin when thinking of the fact that THAT was over. By comparison the next stages aren’t that scary. I probably haven’t completely processed that surgery will change my body for ever. But any feelings of sadness are balanced by the feeling of wanting to get the damn tumor out of my body – it has been itching and hurting a little these days, and as the pre-surgery imaging from last week showed, had shrunk a little in response to the 3rd and 4th cycles of FAC (yay!). Perhaps the scariest thing ahead is the tamoxifen. Some of the men I am in touch with now have shared that they had real issues with the effect on their moods.

For today I am focused on the surgery. I report to the hospital at mid-morning, and expect to stay overnight for observation and be sent home early tomorrow. We call this 24-hour surgery, and you aren’t admitted to the hospital proper. Its somewhere between outpatient and inpatient I guess, and I can see that being back home will be good. Hospitals are great and all, but I’d rather be in my house.

The plan is to take all the breast tissue and overlying skin, but spare the major muscles – hence modified radical mastectomy. Then my surgeon will also do an anatomic lymph node dissection. As she explained to me last week, this means that they will simply take all the nodes in a defined anatomic field, rather than try and determine one by one whether they have or had cancer in them. The field is from my sternum to my right side, and up under the arm. This means that the surgery can proceed pretty smoothly without too many interruptions to wait for a quick assessment by pathology.

The nodes are then sent to pathology, and they will carefully look to see how far the cancer had spread. This information will then help design the radiation field for the last part of my acute therapy. Leaving these nodes, or at least many of them, in would mean that we would be uncertain about the spread, and this would mean higher levels of radiation would have to be delivered to the entire field. If we have evidence that the cancer spread is less, I guess my radiation oncologist can adjust the dose. Anyway – I will report back once we have the results.