Hope for a cancer-free future

On Monday, 30 November 2020, my surgeon admitted me to the hospital for my sixth surgery in just over a year. When a routine mammogram found a suspicious mass in July last year, I underwent a lumpectomy to remove the tumour for testing. 

Following a Stage 2 cancer diagnosis - lobular pleomorphic carcinoma of the breast that is positive for HER2 and hormone receptors - I underwent a double mastectomy and direct-to-implant reconstruction in September 2019. A few weeks later, I was back in the hospital for debridement of the wounds on my right breast. I struggled with wound healing, and due to necrosis and infection, my surgeon once again admitted me to the hospital to remove the right implant in November 2019. 

Upon completion of my chemotherapy regime, I had to wait two more months before my next surgery: insertion of a tissue expander in May 2020 to gently stretch the skin in preparation for the final reconstruction. 

Finally, last month, my surgeon inserted the permanent implant. He also performed liposuction to use fat from my tummy, sides, and back to give my breasts a better shape.

Liposuction sucks!

When I asked my surgeon what to expect from the most recent procedure, he warned me that the areas where he performed liposuction will probably be tender. That was an understatement! It hurts so much; I feel like I was hit by a bus. 

Not only is my body bruised all over my abdomen and back, but also my breasts where he filled them with fat. The pain caused by the bruising makes it almost impossible to fulfil usual functions like bending forward after a shower to dry off my legs and feet. 

Recovery after surgery.

There are many things one needs to consider in terms of post-operative recovery. Because my implants were placed underneath the pectoral muscles, all arm movements must be restricted for 12 weeks post-surgery to allow the tissue to re-attach itself to the implant. If the patient does not follow this after-care advice, there is a risk that the breast shape may become distorted. Sleeping on your back for at least three months is vital to make sure the breast shape remains intact. 

After the mastectomy, the detached pectoral muscles were so weak that I could not use my arms to lift my body upright from a sleeping position. It took about four weeks for the muscles to settle into a more normal state of functioning. Following my most recent procedure, I must once again restrict the movement of my right arm and return to sleeping on my back. But, thankfully, the pectoral muscles are not weakened at all. This, however, brings about other challenges in that I forget to restrict my arm movements.

Let's talk about the tissue expander.

Unlike the permanent silicone implant that is breast-shaped, soft and natural to the touch, the tissue expander is a device designed to be inflated over time with saline solution. It has no aesthetic shape, and the port makes an area of the breast hard to the touch. The gravity of saline is also greater than that of silicone, so the breast is more rigid and heavier. When filled to capacity, the tissue expander feels like a brick in comparison with the silicone implant. 

My recommendation to other breast cancer patients is to opt for direct silicone implants if you meet the criteria. If you must get a tissue expander first, know that it is uncomfortable but not unbearable.

My general state of mind.

My oncologist ordered the next set of scans for February 2021. I cannot begin to explain the anxiety that has become part of my being. My research over the last 15 months discovered that my type of cancer is found in less than 1% of breast cancer patients. What makes lobular pleomorphic breast cancer different is that its cellular structure has a higher mitotic rate. This means that it is linked to lower survival rates because the cellular division is increasingly aggressive compared to different breast cancers. Clinical trials show that the five-year overall survival rate of patients with my specific cancer is 68.5% compared to other types of breast cancer that is 83.9%.

Another study also states that metastasis, or the spread of cancer cells to new parts of the body through the lymph or bloodstream, occurs at a higher frequency than types of breast cancer. Tumours often extend to the bones, gastrointestinal tract, uterus, meninges (brain), and ovaries.

For this reason, my oncologist wants me to go for scans every three months for the next five years. Having all this knowledge from trusted scientific sources leaves a colossal sword hanging over my head. When one lives with the reality that your life may end in a few years from now, one tends to start living day-by-day. I think this makes me overall happier than I was in the past, but it puts a damper on long-term planning. It doesn't mean that I stopped dreaming of the things on my bucket list. It merely means that I am a little more realistic about my wish list. 

But the most significant impact of this realisation is that I don't take my husband and friends for granted any longer. Spending quality time with them has become a priority for me. I worked hard to advance my career to the point it is now, but my job is no longer my life's focal point. In the past, I would accept a project to the detriment of family time. Those days are over. Time is precious, and I want to spend it with the people I love.

All of this does not mean that I lost hope for a cancer-free future. I will continue my fight like the warrior I naturally am. My continued treatment includes a daily oral dose of Tamoxifen and a three-monthly injection of Zoladex for the next two to five years. Furthermore, I just finished a year-long treatment regime with Herceptin. I won't give up the fight!