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Saturday, 6 November 2010

Gory details - don't look if you're sensitive!

I've been asked what the surgery will involve...
The tumour is in the right-hand side of my right breast. The surgeon is concerned that he doesn't leave any cancer cells lurking there when he takes the lump out - tumours aren't nice round balls, they are a bit spidery with bits sticking out into the surrounding tissue. When the lump is removed it will be examined to ensure that the tissue removed has a clear margin of healthy tissue - there must be no cancer cells on the surface.
When the lump was big it was quite close to the skin, so in order to ensure a clear margin there the surgeon wants to remove the skin as well. If he just cuts down and takes both lump and skin it will leave the breast rather misshapen - taking the skin will cause the nipple to be dragged off to the right, so it would end up pointing off to the side. This is obviously less than ideal, so what he plans to do is to make a cut all around the nipple and take a crescent-moon shape out of the skin on the left side, in order to re-centre the nipple on the breast. Sounds awful, but I have seen a breast that he's done this to, and it works quite well. We did ask what effect this would have on the nerve supply to the nipple - he assures us that only the skin is affected and the nipple itself will be undamaged and will behave as it always has.
As the lump is so much reduced from what it was, he's confident that removing it will not leave too much of a change in shape (as long as he sorts the nipple position out) and he doesn't think much reconstruction work (if any) will be required - however this will be assessed after the surgery has been done. If it has left the breast out of shape then he has a number of techniques he can use to improve matters, including packing the void left by the lump with fatty tissue taken from the midriff or abdomen - I have plenty to spare so no problem there!
He will also remove two-thirds of the lymph nodes on that side - because of the initial size and grade of the tumour, and the fact that there was evidence (on the original MRI) of a node being inflamed he is not prepared to take a single "sentinel" node for examination, he wants to get most of them out and checked to ensure that they are not affected. This does bring with it a risk of lymphoedema, which is a swelling of the arm which can be painful and never goes away (although it can be managed), but this occurs in about 1 in 8 patients who have all the lymph nodes removed, so there is a good chance it won't be a problem. Fingers crossed - and it's better than the risk that there is something nasty lurking in there!
It's nearly 12.30 as I write - in a week from now I will be back from theatre, and the cancer will be gone - I will then be able to say that I am "recovering from cancer treatment" rather than "suffering from cancer" - that has to be a better place to be!

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