There had been some good news following my first lumpectomy. The doctor had also performed a sentinel node biopsy to see if the cancer had spread to my lymph nodes. That had come back negative, so there was something to be thankful about.
Just like before, when I went in for the second lumpectomy there was never a doubt for one second that they wouldn’t be able to get all of the cancer out. After all, how much more could there possible be?
The thing is, apparently it’s often rather difficult for a surgeon to identify cancerous tissue during surgery. She is looking at the x-ray to guide her, and she tries to remove as much tissue as she thinks is necessary. The tissue is sent to a pathologist who looks to make sure that there is a clear (negative) margin of cancer free tissue around the tumor. A second lumpectomy (or re-excision) in order to get a clear margin occurs about 20 to 30 percent of the time.
Again, everything went smoothly. Again, we waited for the pathology report. And again the news was not good. There were still positive margins around the tumor. At this point, there would really be no option but to receive a mastectomy on my left breast.
Surprisingly, I was still full of optimism even though it was obvious that I just wasn’t going to have an easy time of anything. I was going to lose a boob; it didn’t really seem like that big of a deal as long as it meant the cancer would finally be gone. In an email to my girlfriends I wrote: “Unfortunately, my latest pathology report did not go the way we were hoping. They were unable to remove all the cancer with the last lumpectomy, and so the next step is a mastectomy on my left breast. I will be meeting with a plastic surgeon to see if I’m a good candidate to start reconstructive surgery at the same time they do the mastectomy. That is what I’m hoping for — get rid of this damned boob ASAP and get a perky, youthful one in its place. Maybe they’ll even do a little lift on the right side; it’s the least they can do after all!”
But when I met with the plastic surgeon and he started talking about all the reconstruction choices I had, I felt immediately overwhelmed. We weren’t talking about just one surgery, but multiple surgeries over time to replace implants, to make the right breast symmetrical with the new one, etc. Would I use saline or silicone? Was I going to use expanders? Did I have enough of my own skin or would they need to take it from my abdomen or back? How would the new breast be affected if I had to have radiation therapy? It was more than I could handle. So I ultimately decided to be lopsided and worry about reconstruction later. Baby steps for this baby.
I went back to work for about a week and half between surgeries. I missed my students. While I was gone many of them had made me cards that were so sweet and adorable. When I got back to the classroom, they had lots of questions about why I’d been gone, and I tried to be evasive. I didn’t want to tell them I had cancer; I didn’t want them to worry. So I just told them that I had had a couple of surgeries.
In the middle of class, one boy looked me up and down and said, “Where did you have a surgery?” The other students told him he was being rude, and I just smiled and told him that if he wanted to talk to me about it he could see me privately after class, which, thankfully, he never did.
I told my students that I would be out again for a couple of weeks, and they were not happy about it. Fortunately, we had been very lucky to have two wonderful substitute teachers during my absences. I was still making lesson plans and correcting my students’ papers, so they knew I was keeping an eye on them. When I left them again, on March 19th, I got lots of hugs, and I told them I’d be back soon. None of us knew then, that I wouldn’t be back for the rest of the school year.