When I received my second breast cancer diagnosis on May 15, 2025, it became my prayer that all of the right doors would open for the surgery and treatment path I was supposed to take. However, what I'd failed to consider at the time was that the right doors opening also often means the wrong ones slamming shut. The plan had become so clear and felt so doable. All of a sudden, a complication arose and the whole thing was thrown in jeopardy.
My pre-procedure mammogram the morning of my Magseed placement had revealed two brand new suspicious microcalcifications, both on the same side as my previous diagnosis. On the day of what should have been my 2nd lumpectomy, I found myself once again at the radiology clinic, face-down on the Table From Hell, undergoing my 4th and 5th stereotactic biopsies simultaneously. (These were actually my 5th and 6th biopsies in total, but one of those had been ultrasound guided, rather than stereotactic.)
So far, I was 1 out of 4 on my biopsies coming back benign. With that track record, it was hard to feel optimistic. My most recent biopsy on May 13th had gone so poorly, too. I'd bled so badly, they couldn't even do a post-procedure mammogram to verify the clip had been placed correctly. They eventually sent me home with ice packs and gauze packed tightly under a sports bra. Six weeks later, I was still very sore and bruised all over, and the giant hematoma that had formed underneath the incision was still quite large. How much worse was this going to get before my eventual surgery?
Fortunately, my procedures that day went much better than the previous one. I don't know if it was because I was more prepared, or if the radiologist I had that day was just that good. It took less time to do those 2 biopsies than the Women's Imaging Center had taken to do just one. The funny part is: when it comes to biopsy clips, there are only 3 shapes to choose from in order mark each site. My first 2 clips from 2017 had been removed during my lumpectomy, but I still had the one from my benign biopsy later that same year, plus the most recent clip from this past May. Now that they were adding two more, they had to double up on one of the shapes by using 2 side-by-side, just to distinguish it from the other site with that same shape. I was really amassing a collection in there!
Brian came with me to the appointment and waited outside in the waiting area. I emerged roughly an hour later, bandaged up in ace wrap with ice packs underneath, but feeling relatively OK. I was actually surprised how little discomfort I was in. Still, Brian felt I deserved some post-biopsy ice cream, and I agreed. It's wonderful having a man who tends to all of your needs like that!
Brian's mom had flown in for a 3-week visit on June 21st and was staying with us through July 13th, so she was able to watch Avery while he and I were at my appointment and subsequent ice cream "date." My mom had wanted to come down for my anticipated surgery date on the 3rd, but an emergency surgery on my uncle followed by a death in the family shortly after kept her from being able to do so. With Mom and her sister now solely responsible for taking care of my grandma, who needs 24-hour care, my uncle needing surgery meant my aunt KoAnn would be preoccupied with that, so Mom had to wait to come down until after he recovered, freeing KoAnn up. Mom ended up buying a one-way plane ticket from Ohio to Virginia on Saturday, July 12th. The plan was for her to stay 2 weeks, with my brother Rob driving down on the 19th and staying for the second week, then he would drive the two of them back up on the 27th. This was all decided prior to my surgery being postponed, though. Unable to change her plane ticket, my mom kept the original plan and hoped my surgery would either get rescheduled for while she was here, or that she could come back whenever it ended up happening.
I spoke to my breast surgeon shortly after my Magseed placement got cancelled in light of the radiologist's findings the morning of the 30th. She admitted she was surprised by this sudden turn of events, but said she trusted his opinion and felt he was probably being overly cautious due to my history. She said we would reschedule my lumpectomy at the next soonest time her schedule aligned with my plastic surgeon's, and proceed with the current plan unless something changed. I asked her how often something like this happens and it turns out to be benign. All she said was she sees it happen a couple of times a year. No answer on how often the new findings are benign vs. malignant. That seems to be the forbidden question no one wants to answer.
My surgery being postponed also meant needing to postpone my post-op follow-up with my radiation oncologist. When I contacted their office to reschedule that, I also asked whether my DCISionRT results had come back yet or not, just out of curiosity. I was told that they had but the doctor would need to be the one to go over them with me. So we kept my appointment as-is but made it a telehealth visit just to discuss those results. I also scheduled a telehealth visit with my breast surgeon for Friday, July 11th to discuss the biopsy results, assuming they would be in by then, and go over my surgery options. The holiday weekend on the 4th likely meant a slight delay in getting those results. But I still checked my patient portal every single day, often several times a day, hoping to see some results uploaded.
I was already losing hope that I would be able to have the breast-conserving surgery I had worked so hard to secure. And the more days went by without the results, the more that hope faded. I felt that if it were good news, I would have heard something already. Besides, what benign conditions pop up in the span of four weeks like that? I was mentally preparing myself for needing a mastectomy. This boob was all but a goner.
The one nice thing about my surgery being postponed from the 3rd was that we could use the tickets I'd bought for the "Celebrate America!" concert at the Kennedy Center that night. I wasn't sure how rough I would feel after having a double biopsy earlier that day, but I was surprisingly OK. As long as I kept the ace wrap on, swapped the ice packs regularly, and kept up on the extra strength Tylenol, I was in fairly good spirits. It was our third time attending that annual concert and, as usual, it was incredibly enjoyable. However, I was battling a summer cold and had almost completely lost my voice, so I couldn't sing along during any of the audience participation numbers. Something inside me had to wonder if this was by design.
In my head, I'd been equating having a mastectomy with my dad having a laryngectomy, since both were irreversible yet necessary surgeries that had profound effects on the patients' personal relationships for the rest of their lives. Being unable to sing along at the concert was like a short glimpse into the frustration my dad must have endured for 30+ years. If I ended up needing a mastectomy, it would undoubtedly be life-altering and deeply painful, both physically and psychologically. But not nearly as bad as not being able to talk or sing ever again. A mastectomy you can hide, a laryngectomy you can't. Was this summer cold I was battling really my dad poking his head out from clouds and reassuring me that losing a diseased breast maybe wasn't the death sentence I was imagining it to be? Perhaps there are worse things.
During the week of waiting on my biopsy results, I learned that my lumpectomy had been rescheduled for Wednesday, July 23rd. This meant my mom would be here for it. However, that could potentially interfere with Brian's and my vacation plans on the 31st. Brian said we could change the date if needed, or we could just turn it into a low-key weekend of R&R. I definitely did not want to change the date since we'd been planning it since Christmas and I'd already put in for those days off from work. Plus, not knowing the biopsy results yet meant not knowing whether my surgery would even go forward as planned or if they would have to push it out even further since it could end up being a much larger operation. So many things hinged on these test results.
The morning of Friday, July 11th, I arrived at work and immediately logged on to my patient portal. It had been over a week now. Surely something had to be in there!
Nope, still nothing. My telehealth appointment with my surgeon was scheduled for 1:15 that day, so I was getting nervous we wouldn't even have the results before then. I was also starting to wonder if maybe they were withholding them from me for some reason. I kept refreshing my screen every so often, just in case something got uploaded, all while trying to get my work done as normally as I could.
At precisely 11:51 a.m., my phone buzzed with an email notification. It was from MyChart. I had a new test result.
"Oh, God. This is it." I said softly to myself. My hands shaking, I clicked on the link in my email and logged on to my patient portal. I went to the test results tab, clicked on the newest one, and downloaded the pdf containing the pathology report. I took a deep breath and a huge gulp of air as the document popped open on my computer screen, the results leaping out at me in bright red italic font.
Specimen #1 - Diagnosis: "Ductal Carcinoma in situ, intermediate to high nuclear grade, clinging pattern, with associated necrosis and calcifications."
Specimen #2 - Diagnosis: "Ductal Carcinoma in situ, intermediate nuclear grade, solid and cribriform patterns, with associated necrosis and calcifications."
Fuck.
More cancer, more cancer, more FUCKING CANCER!!
It was over. There was no way I could still do breast-conserving surgery now because there was no way I could do partial breast radiation. Three separate cancers in three different areas (plus whatever else was in there that just hadn't shown up yet) would render that impossible. So what now? I needed to take a walk to clear my head.
I grabbed my purse and just started walking. I went outside the office building and made my way onto the W&OD trail where I started putting one foot in front of the other with fury. My mind was racing. I was going over every possible scenario in my head and every possible outcome. Finally, I had to tell myself to stop thinking and just wait to see what my surgeon said when we spoke in an hour. I'm not sure exactly how much ground I covered during that time, but according to my FitBit it was 2.3 miles.
Eventually, I made my way back to the office. It was one of my coworker's last day at the firm, so there was a bit of a send-off party with cake happening in one of the conference rooms. I had no appetite for any of it, though. I couldn't even eat lunch. Fortunately (or unfortunately), news travels quite fast in that firm, so pretty much everyone had already heard about my test results by the time I came back from my walk. The partners had all been very understanding and accommodating throughout my first bout with cancer, and later my pregnancy and maternity leave despite it coinciding with the pandemic. My boss sensed my distressed mood that day and gently led me back to my office, where she assured me they would work around whatever time off I needed for surgery and recovery. She then practically ordered me to take the rest of the day off without even marking myself out or using PTO. "This one's on us!" she said. Typically, I would've just powered through the rest of the day and pretended everything was normal. But since Brian was working from home and his mom was visiting, plus I had a telehealth appointment starting in 15 minutes, I decided I may as well get some family time in. First, though, I needed to talk to my surgeon.
After I shut everything down in my office and bid my departing co-worker one last farewell, I went into one of the restrooms and huddled down in the large stall on the end. I logged on to my patient portal and clicked on the prompts to join the telehealth call. My surgeon entered the call shortly thereafter.
"So, we got your biopsy results." she began.
"Yes, I know. I saw them." I told her. She seemed surprised that I'd already seen them. (She apparently didn't know me well enough yet to not know that, when it comes to things like this, I'm a borderline stalker.)
"Unfortunately," she continued, "this is going to change the plan."
I knew that, too. With 3 new cancers now growing inside my ducts plus my prior lumpectomy site, not only would there be so little breast tissue left after a lumpectomy, but it would not even be safe to leave any remaining tissue behind. For whatever reason, my boob was on the warpath and the only option was to stop it dead in its tracks. I needed a mastectomy. Period. Hard stop. The only thing up for debate was...
"What about reconstruction?" I asked shakily, reminding her what my other surgeon had said about me not being a candidate for implants due to their tendency to adhere to radiated tissue, leaving DIEP flap my only option.
"Well," she replied, "I've found that silicone implants are safe even after radiation, so we should be able to go with that."
Wow. Another opinion that differs entirely from what I was originally told. Still, it was like choosing between a rock and a hard place. None of the reconstruction options available sounded remotely appealing. But I suppose a silicone implant was the least unappealing one of all. The recovery time was much shorter than DIEP flap (2-4 weeks as opposed to several months), and silicone tends to feel more natural than saline implants. However, there are still risks involved like leakage, rupture, encapsulation, and infection, and the need to have them swapped out, which would require additional surgery and recovery. No matter what, I will be a plastic surgery patient for the rest of my life.
I asked my doctor how often I would need to have an implant swap and she said that, although the recommendation is every 10-15 years, nobody really does that. She did recommend meeting with my plastic surgeon again to discuss all reconstruction options, so I said I would call his office that afternoon to set that up. Fortunately, my surgery on the 23rd could still proceed as scheduled since the whole procedure would only take about 2-4 hours (as opposed to a whole day for DIEP flap). She would just change it from lumpectomy to single mastectomy. I expressed concern over the date being so close to my planned vacation in Michigan. She said she remembered me telling her about that, but said she felt I should be OK to still go, as long as I took it easy and didn't push myself. The surgical drains, though, might be a bit of a hindrance. I had to keep them in for 2 weeks post-procedure and empty them twice a day, plus record the output. Spending a romantic vacation on Mackinac Island is decidedly less romantic when you have to wear a surgical bra with tubes and drains hanging from it, and record how much fluid is leaking out of them. I would also not be able to swim, soak in a hot tub, or even wear a bikini. It was shaping up to be a very low-key weekend with maybe a few light walks. Not what I had pictured at all.
My doctor then went over the options I had for checking for any lymph node involvement. Since I'd already lost 4 lymph nodes during my lumpectomy, I told her I didn't want to lose any more if possible. My prior surgery had required a Sentinel Lymph Node biopsy since my cancer was invasive. However, with a mastectomy, they can do a Magtrace injection, which is a non-radioactive lymphatic tracer injected into the breast tissue that travels through the lymphatic system to the sentinel lymph nodes. It stays inside the body for a month before being filtered out by the kidneys and naturally expelled. So rather than removing any lymph nodes during surgery, they would just remove the breast tissue and have pathology check for clear margins. If the margins are clear with no invasive disease, no further action is needed. If they aren't clear, they can go back while the Magtrace is still in the body and remove any sentinel nodes for biopsy. Sounded like a good option to me.
She also mentioned nerve grafting, which my old surgeon had brought up the day of my consultation with her, but I was too upset to pay any real attention. Basically, they would attempt to reconnect some of the nerves severed during the breast removal process in order to restore some sensation to the breast and chest area. However, since nerves can take up to a year or more to regenerate, we wouldn't know how successful it was for at least that long. That part was towards the bottom of my list of concerns, though.
I asked about the surgical drains. She assured me they weren't huge and that I could hook them onto my surgical bra to keep them somewhat hidden. I tried to picture how that would come into play during vacation, but it was hard since I had no real clue what they looked like. In my head, I had so many other questions, but couldn't muster the energy to ask them all right then. I was just anxious to call my plastic surgeon's office to make sure I could be seen before my surgery, so I called as soon as I hung up from my breast surgeon. They were able to get me in for a follow-up consult the following Friday, July 18th at 3:15. Brian was scheduled to be home that day, so he could come with me to be a second set of eyes and ears while my mom watched Avery.
My mom flew into Virginia the following afternoon, then Brian's mom flew back to Michigan the morning after. During the weekdays that followed, I scheduled my pre-op anesthesia interview for 7:30 a.m. on Tuesday the 22nd, the morning before my surgery. I also canceled my follow-up with my radiation oncologist for the 14th, stating her services were "no longer indicated." I asked her about my DCISionRT results, though, just to satisfy my own curiosity. I was informed that, as was probably no surprise to anyone, the results had come back showing I was in the highest risk category, so radiation would have been an absolute necessity if I'd been able to have a lumpectomy.
I also scheduled a haircut since I didn't want to deal with super long hair during my recovery. I told my stylist to take off 3-4 inches and do some layering, but she apparently started with 4" and kept on going. It was quite shorter than I was used to. But on the upside, it was less hair to have to manage with only one fully functional arm.
Brian accompanied me to my appointment with my plastic surgeon on the 18th. The nurse clearly felt the need to make sure I was OK with him being in the exam room with me. "He's your...?" she asked, trailing off as she waited for me to fill in the blank. I replied, "Yes, he's...uh, mine." That appeared to be satisfactory. After I'd changed into yet another open-in-front exam robe, Brian and I waited in the exam room for a few minutes, lightheartedly joking about various bodily enhancement procedures we could have done there. The mood turned somber, however, as soon as my surgeon entered the room. I hadn't paid much attention to what he'd talked about during my initial surgical consult since I was so determined not to have to need him, so it felt more like an initial consultation than a follow-up.
He echoed most of what my breast surgeon had already told me, like being under general anesthesia and the surgery would take 2-4 hours total. The surprise twist was when he said I would be getting an expander put in first rather than going directly to implant. I had not been prepared for that, and my disappointment with this revelation showed. He then backtracked slightly, stating there was a small chance I'd be able to go directly to implant depending on what happened during surgery (mostly with regard to how thin and elastic my skin was), but the most likely outcome would be an expander first, then a second surgery three months later to swap it out with the actual implant. That meant I'd be going under the knife again right around Halloween. So much for being able to enjoy that holiday this year. He did assure me it's a much, much easier surgery and recovery than the mastectomy would be. But still, I was not happy at all with this news. I'd already lost out on fully enjoying the Fourth of July, and possibly our pre-planned vacation. The other upsetting revelation was that, as long as I had this foreign object inside my body, I would be much more susceptible to infection, so I would need to take prophylactic antibiotics for pretty much every future medical procedure, including a routine dental cleaning! All these little annoyances were really piling up, reminding me why I fought so hard to avoid having this surgery in the first place.
I asked him about the periodic implant swapping process, which my breast surgeon had downplayed by saying no one actually does it. He responded that my implant will be monitored regularly to check for problems and if there's nothing wrong, they will leave me alone. They only swap it when there's a problem. I was starting to have a feeling that the first sign of a problem would likely be my last. I wasn't ready to do DIEP flap or go completely flat at this stage of my life, but I could already sense the day coming when I would want to be done with all of this implant nonsense.
My surgeon closed out our appointment by telling me I was 100% making the better choice by having a mastectomy and I would be much, much better off down the road this way. Always easy to say for someone who's not facing this surgery. I wanted to say that it absolutely was not MY choice. I'd been backed into a corner by my own body turning against me yet again. My flight-or-fight response had simply changed gears from 'flight' to 'fight.' Nothing about this was fair, or voluntary.
For the next 5 days, I felt like everything I did was my last hurrah. My last anything with two breasts. It was almost like a countdown clock to Judgment Day. I wanted time to stop so my surgery would never have to come. But at the same time, I was so emotionally spent from worrying about it, I wanted to just put it in the rear view mirror already. I was tired of wondering what might happen and wanted to see it actually play out. As they say: anticipation of death is worse than death itself.
The morning of Wednesday, June 23rd dawned as expected. I had to arrive at the hospital at 6:30 a.m. for pre-op registration, with a surgery time of 8:30. I set my alarm for 5:00 a.m., but I was awake long before it even went off.
The morning of my lumpectomy, I'd had to apply a special lidocaine cream so they could inject the radioactive dye before the procedure. There was none of that this time. I just had to shower and clean the surgical site with hibiclens, a special anti-bacterial soap that doctors often use when scrubbing in.
As I was getting dressed after showering, I was trying to find the perfect outfit to wear for my last few hours as a two-breasted person (as if such an outfit exists). I dug through my shirt drawer and pulled out a shirt that had been gifted to me by a coworker 8 years ago, after I received my first diagnosis. I didn't get to wear it much but, when I did, it always drew praise. It was a simple black crewneck t-shirt with gray letters on the front that spelled out "Hey Cancer, Fuck Off!" I asked Brian if he would be embarrassed or offended if I wore it to the hospital. I was completely expecting him to say yes, so I was surprised when he shrugged his shoulders and said, "No, that's fine." My man totally gets me!
Just before 6:00 a.m., I knocked on Avery's bedroom door. My mom was in there sitting up in the twin bed with her Bible open, while Avery slept peacefully in her toddler bed. Mom asked if we were leaving for the hospital now and I nodded yes. She reminded me she would be fasting and praying along with her church prayer group all day from 6:00 a.m. to 6:00 p.m. I leaned over Avery and gave her several deep kisses on her forehead, as if it would be the last time I saw her. Then I turned and walked out of the room, closing the door behind me without a word. At the top of the stairs, I suddenly stopped and paused. It was almost like an ethereal voice spoke to me with three simple words: "Hug your mother." I hesitated a minute before turning around, then marched back into Avery's room,walked over to the twin bed, and hugged my mother. "I know you'll do fine." She assured me. I couldn't even respond except to wave my hands, wishing it all away. That was the first of three times I cried that morning.
I had never been to this surgical facility before. Since I'd consulted with my surgeon in Leesburg, I'd been under the assumption my surgery would take place there, too, but I'd been mistaken. My pre-op instructions sent to my patient portal informed me my surgery would actually take place at the Falls Church location. The Inova Fairfax hospital campus was a giant maze of multiple buildings with color-coded parking garages. Much bigger and more complicated than Reston. We'd been instructed to park in the blue parking garage and go to the Professional Services Building. Even with GPS, we still got lost and went to the wrong garage. It was 6:45 by the time we found the garage we were supposed to be in. Right as we were pulling in, the hospital called me to see where I was. I let the woman on the phone know we were parking right now and would be there soon. I still had to keep her on the line so she could direct me to the right place, on the third floor surgery suite.
There were two ladies at the registration desk. One complimented me on my shirt right away. Upon checking in, they handed Brian a form with my patient number handwritten on it. They explained that he would be kept apprised on my status all during pre-op, surgery, and post-op via a giant screen in the waiting room indicating by patient number which stage of the procedure I was currently in, so he could follow my progress along. I quipped that it was like ordering a pizza from Domino's. We both got banded with our respective "patient" and "visitor" wrist bands bearing my patient number. After about 15 minutes of waiting, they called me back. Brian was not allowed back there with me just yet, so we kissed and hugged good-bye before they led me away. Upon reaching my pre-op room with the bed on a stretcher, they asked me all the usual questions (name, date of birth, what procedure are we doing, which side) and proceeded with their usual branding of the correct side with purple marker.
There were a lot of people that came and went during the next 90 minutes or so. Several nurses, my anesthesiologist, and of course both my surgeons. While sitting in the pre-op room and lying on my bed answering their many questions (and thereby being forced to admit out loud what I was having done that day), it became the second time that morning I started crying. The nurse in the room with me at the time simply handed me the box of tissues sitting on the stand next to her. I'm guessing it happens fairly often.
When my anesthesiologist came in, he had more personality than I was expecting from someone whose job is putting patients to sleep. He asked about my medical and surgical history, allergies, current medications, etc. I said I'd been put under general anesthesia many times and always did very well. I asked him what drugs he was planning on using on me and he gave me the full list, including Fentanyl as a premedication to help me relax. I mustered up enough humor to quip that it wasn't every day I got to tell people I'd had fentanyl in my system.
After my anesthesiologist bid me adieu until the OR, it was my plastic surgeon's turn. His role was fairly crucial since he has the onerous task of ensuring everything looked as symmetrical as possible. He had me stand up straight with my arms stretched out to my sides, then he opened my gown from the front and began marking me all over with purple marker. He marked me up on both sides, his brow furrowed with concentration, like Michelangelo sculpting David. I inwardly laughed at the realization that this man, sitting there and marking up my whole chest and torso, was literally at work right now.
The last face I saw before the procedure, although I didn't recognize her at first all masked up and with a surgical cap covering her hair, was my breast surgeon. It wasn't until she mentioned being grateful for the radiologist discovering the two new abnormalities that it clicked in my head who she was. She went over the details of the procedure, explaining how she would make the incision in the inframammary fold and remove all of the breast tissue, all the way up to my collarbone and over to my sternum. Since we were doing a nipple-sparing mastectomy, they would have to leave some tissue behind inside the nipple in order to keep it viable, which necessitated first checking the tissue immediately behind the nipple to make sure no disease was present. She said she would do that right away and hand it to "Frozen" who would check it on the spot under a microscope. If it was clear, we could proceed as planned. If not, nipple sparing would no longer be possible. She also reiterated the plan for nerve grafting, assuming they could find a good nerve to graft. So there were still plenty of variables at play. It all sounded so incredibly intricate and complicated, I couldn't believe they only estimated the whole thing to take 4 hours.
By the time my surgeon exited to go prep for the surgery, it was right around 8:15 a.m. and Brian was finally allowed back to my room to see me one last time. I gave him my purse to hold onto (much to his chagrin) along with my phone and whatever personal items I didn't want the hospital to lock up. He kissed me one last time and wished me good luck. I gave him a mournful look, knowing the next time I saw him, I would essentially be an amputee. Time was both moving too fast and too slowly. The nurses then pushed me out of the room, my IV in tow, and began to roll me down the hall towards the OR. I was immediately taken back to the evening of my emergency C-section, feeling like I was being led to the executioner, but with slightly less urgency this time.
They turned towards the right and wheeled me into Operating Room 6 (Brian's lucky number, for what it's worth). The room was freezing, as usual. The nurses had me slide from my bed over onto the operating table, then draped a few warmed blankets over me. The rest of the room was abuzz with activity. The weight of knowing what was about to take place began to really set in, thus leading to the third and final time I cried that morning.
Eventually, the anesthesia nurse placed an oxygen mask over my face, which made me feel like I was being suffocated, so I pulled it away slightly. My anesthesiologist soon appeared above me and started making small talk, asking about any destinations I was planning on going to or would like to visit someday. I knew he was trying to get me to talk so I would breathe in the gas, so I played along, obediently. I told him about Brian's and my vacation plans to Mackinac Island, scheduled to happen in just 8 days. While I was talking, the gas in my mask took on a vile taste and odor, which I balked at while trying to keep talking and breathe it in anyway. Then everything went black.
My Judgment Day had arrived and I had absolutely no idea what to expect when (and if) I woke up.
To be continued in part 4...
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