# Cancer Lesson #17: An Equation

Cancer Lesson #17: An Equation

As mentioned in Cancer Lesson #6, my cancer was ductal, one of the most common varieties of breast cancer. After all the scans and blood draws, it seemed to be just as it appeared – with a single site that had spread to at least one lymph node.

I was lucky. My doctors told me since I was “young” (ha) and “fit” (double ha), I had choices, which I wrote into an equation that looked like this: (R + L + C) = ([M + {r1 or r2}} + C)

R is radiation, L is lumpectomy, and C is chemotherapy. M is mastectomy, and r1 and r2 were my options for reconstruction using implants or a TRAM flap. Of course, there was also the option to not do a reconstruction and wear prosthesis for the rest of my life, a choice many women make.

What was not an option was avoiding surgery altogether. And since my cancer was already in a lymph node, a sentinel node biopsy – where they remove only a few lymph nodes to verify the cancer hadn’t spread – wasn’t advisable. I needed a axillary lymph node dissection, which meant Dr. S would remove as many lymph nodes as she could find to see how many were affected.

The first part of the decision was easy. I’m small-breasted (read “flat”), which meant even a lumpectomy would be noticeable. Plus, I didn’t want to have radiation.

I could have had a bilateral mastectomy, removing both breasts and thereby considerably lowering the chance of recurrence, but that seemed like overkill. Also, if I decided on a TRAM flap reconstruction, I didn’t have enough stomach or back tissue (fat) to make two new breasts. (Too bad they don’t use thigh and bum fat!)

So, a single mastectomy it would be, but with what kind of reconstruction?

Choosing implants meant my new breast could be any size I wanted, and the plastic surgeon would make the other one match. A TRAM came with size limitations, but without the possible later complications involved with implants. (As WebMD says, “Breast implants are not designed to last a lifetime.” See here for the rest of the article: http://tinyurl.com/mkte47w.)

The decision, in my mind, came down to this: Did I want to have look like more like Barbie or like me?

I got a lot of comments on that blog post and the accompanying Facebook status, ranging from “Go for it!” to “Women aren’t beautiful because of their breasts; they’re beautiful because who they are.”

One friend, who shall remain nameless, commented that he’d always had a fondness for the airport in Salem, Ohio (airport identifier: 38D). Having pretty much settled on a TRAM by that time, I replied that I would probably continue to have a lot more in common with Laurens County, South Caroline (airport identifier: 34A).

Interestingly, the “go for it” and the “you’re beautiful just as you are” comments were equally divided between women and men.

The Engineer wisely didn’t state a preference. Finally, in a fit of self-pity (using my most pathetic voice), I asked him, “Will you still love me when I don’t have a real boob anymore?”

His reply? “I’ll just have to love you somewhere else.”