WIRED

Pre op appointment went ok on Thursday. They found that Sam may be anaemic because her last blood test showed a low red blood count (this would explain the tiredness and lack of energy) so they retook another test to see if it had risen at all. If it’s low again then they’ll consider giving her a transfusion at the same time as the surgery, however, if it’s too low then the surgery could be under threat.

We had the meeting with Nia (our cancer nurse) and she went through what would happen tomorrow before the surgery. First thing she said was that this would be nowhere near as painful as the Sentinel Lymph Node biopsy that Sam had (which is nice to know). She also said that her recovery time from the anaesthetic would be slower due to the chemotherapy that she’s received and even though it’s day surgery, they expect that she’ll be in overnight.

Tomorrow, Sam will have what is called a “Wire Localisation Procedure” to prepare for the lumpectomy. She will go into the hospital at around 1030 where she will head over to the radiology department to see the consultant radiologist. He will give Sam an ultrasound to see where the lump is and then he will then insert a very fine needle (with a hollow middle) into her breast and place it directly in the centre of the tumour (more or less close to the clip that they put in at the beginning). Once the needle is in place, a slender wire is fed down through it’s middle and placed directly into the tumour. The needle is then withdrawn, leaving the wire in place. The radiologist will give Sam another scan to check that it’s in the right place and If it isn’t, then the sequence starts again. As soon as the optimum position is found then the wire is secured in place with a bandage or some tape.

The wire will act as a centre point for the surgeon who will use it as a guide when performing the lumpectomy. She will cut around and then remove the tumour by pulling it out like a plug (and completely intact) along with a good amount of healthy tissue surrounding it. This will then be sent off (completely intact) to the labs to look at under the microscope. Over the next 10 days they will be looking for a good amount of “healthy margins”. This is when the tumour has at least 1mm of healthy tissue all the way around it. If at any point they find that there is no healthy tissue (or there isn’t enough) then Sam will get called back into surgery and will have more tissue taken out until the margins are completely “healthy”. If, however, they find that they don’t have enough healthy margins the second time, then Sam will be offered (and recommended) a full mastectomy. There is no third attempt. This is usually a rare scenario though and only happens in a small percentage of cases.

We then talked about one of Sam’s main dilemmas. Mastectomy or lumpectomy? A lot of women choose to have a mastectomy straight away because they simply don’t “trust” their breast any more. They want it gone because they don’t trust it to not to go wrong again. Most women that Sam has talked to say that, if they were ever in her position, then they would opt for a double mastectomy to be certain the cancer is gone completely. This isn’t always an available choice. The NHS would never do a double mastectomy if only one breast had cancer in it. It’s only if they find the patient has the BRCA gene that they will consider this option. Also, after a mastectomy is carried out, its usually 18 months before any reconstruction can begin. This can be quite traumatic for some people as there is a massive amount of adjusting to be had during this time. A lot of people assume that everything (removal and reconstruction) is done at the same time but that’s not the case. The only time they would do a reconstruction at the same as the mastectomy is if the patient was not going to have any radiotherapy treatment. There is also evidence to suggest that having a lumpectomy and then radiotherapy treatment on the infected area is just as effective as having a full mastectomy. Also, another concern is that, say that after the lumpectomy is completed, Sam is left with half of her breast missing. She may as well have gone the whole hog, had the whole thing taken away and start again fresh with a full reconstruction. There’s nothing to suggest this would be the case and to be honest, nobody knows what’s going to happen until after tomorrow. They do these procedures in their thousands every day so we have to put our trust in the surgeons and hope that things will be ok. After all, most people who have gone through this journey would have already had this procedure done at the beginning. It’s only Sam (the awkward one) who’s doing it ass about face. 😉