Everything sucks, but at least I wore cute shoes.

Week 6 A.D.

Christmas was over, which leaves me feeling a bit sad every year. Typically, I take time off this week each year but youth sports travel took up all of my vacation. On top of work, I had doctor appointments scheduled every day this week for Jillian and I except for New Year’s Day, to keep me distracted.

Jillian had her final follow-up with the ENT on Monday. Her nose was doing great and there were no other painful stitch or device removals (thank God for both of us!). She had a cold the week of Christmas, which had set back her healing process a week or so, according to the doctor. She just needed to keep flushing her nose with saline. She also had her follow-up with the orthopedist on Friday to check out her foot after being in a boot for six-ish weeks. All was good there too.

Tuesday was my annual “ladies exam”. Before cancer, these annual check-ups never concerned me. They were something I did on autopilot. They were no more stress inducing than going to the post office. But now, after cancer, things were different. I never expected the bad news to happen to me. So this appointment felt different this time. I was more aware, alert, and nervous.

I was meeting a new gynecologist today, as my former had moved. Ever since my favorite OB/Gyn retired, the one who delivered all three of my kids, it seems like I’ve bounced between nurse practitioners or doctors every couple years. This new doctor was pleasant, spoke very matter of fact-ly and we bonded over my Rothy’s clogs…which have been a hit with about every female nurse or doctor I’ve met with on my latest health journey. For the first time at these appointments we bypassed the breast exam. What was the point? We know what’s in there. I briefed her on what I knew about the treatment plan. After all, breast cancer treatment will interrupt my reproductive system which is, now, in her care.

She sensed my dread and sarcasm when I mentioned early menopause and a chance for a second, natural, menopause if I was lucky. She pointed out that there are drugs available to help with side effects of menopause that are hormone free. Apparently, they shouldn’t interfere with treatment and can help with the hot flashes and other fun treats that might make me feel like I’m dying or going crazy.

I realized I don’t really even know what to expect. I had moved out of state by the time my mom went through menopause. But I also don’t remember her talking about it much. It’s amazing to me that a woman’s body goes through so many metamorphoses during a lifetime, and we are often so quiet about it. Our female bodies are amazing and terrible. Miraculous and terrorizing. Beautiful and horrifying. Now, more than ever, I feel like I’m fully experiencing the perplexing irony of being a woman.

The rest of the appointment went as they usually do. Uncomfortable for five seconds, then redress to reclaim my dignity. No news is good news for these appointments. There was still no news as of three weeks later.

The next day I was back in Overland Park, where I went for imaging. I would have another ultrasound on the troublesome area in my left armpit that swells before each monthly cycle. My oncologist ordered this after he got to see it, fully swollen. But what was really on my mind was my appointment with the surgeon, who I would meet with first, at this same location.

Zach and I checked in, I got my hospital wristbands on, and headed straight for the coffee cart. The barista was a charming man who teased Zach that he wouldn’t tell his wife that he was here buying coffee for this beautiful woman (me). Cute and yet a little disturbing.

When my name was called, we followed the nurse to check my vitals, then navigate to my room, where I undressed waist up and put on a white robe. It was a cotton waffle texture that reminded me of a spa robe. But this was not going to be a relaxing spa experience. A young doctor came in to talk and ask questions about my diagnosis. I guess she is the surgeon’s assistant of sorts, maybe a resident? I really don’t know how medical school health systems work.

My surgeon arrived. “Cute shoes! Rothy’s?” she asked. “I need to get some of those if they come in pink. That’s my color.”

I looked down to see she was wearing sparkly, hot pink clogs to match her smile.

“We are going to take care of you,” she assured.

Maybe the other doctor let her know I got a little emotional talking about the cancer.

“Your cancer is very treatable. No one wants it, but this is the kind you want if you have it.” She repeated what I had already heard before. “We can do one of two things, it’s completely your choice: lumpectomy or mastectomy.”

My body went cold at the last word.

She would use the titanium biopsy marker that was left in me to locate the cancer. The lumpectomy would remove the lesion, along with some surrounding tissue, to ensure complete removal. Then she would rearrange the tissue to make it look like nothing had ever happened. No holes or dents.

In surgery I would need to have lymph node radiotracer (radioactive dye) injected near the region to check for the sentinel lymph nodes, the primary lymph nodes that might catch and spread cancer into the lymphatic system. She would remove two to three of these lymph nodes and check if any cancer has passed through. This test will help oncology determine the cancer stage and best treatment plan post-surgery. Because of lymph node removal, I will need to visit with a lymphologist post-surgery also.

After surgery I might also have radiation treatment on the right breast, the ensure all cancer cells are destroyed. With more recent advances, I may only need a few radiation sessions in a matter of a week or two versus the many over a longer period of time.

Ugh. Still.

She then explained that after all of this. I needed to understand that I will continue to be at risk of getting breast cancer again. Not because of this diagnosis, but that a woman’s risk of breast cancer is always existent if you have breast tissue. The risk will compound with each year. Since I’m 43, my risk is about 25%.

“Fuck!” I blurted. “I don’t want to do this again.”

“I understand. Consider that you also have a 75% chance of not getting breast cancer again,” she replied.

The mastectomy route could remove just the right breast or both, with the assistance of a plastic surgeon. I would have some reconstruction options. She would do a skin sparing mastectomy so that I have tissue for whatever reconstruction path I take with the plastic surgeon.

“Basically, I take the pillow out of the pillow case,” she explained. “You may have the option for implants or you may be able to use your own fat and tissue from other parts of your body to reconstruct new breasts. The plastic surgeon will determine what options you’re a candidate for. Either way, we do our best to make it look natural. But, you need to know your breasts likely won’t feel natural or normal to you. Possibly ever”

I bawled. She was being real. And honest. But damn, that was hard to hear. I just wanted normal back. But I didn’t hear that option.

I asked her for more insight on the implant option. As a 34DD, I’ve never considered implants but I have watched enough episodes of the tv show ‘Botched’ to scare me enough. She explained that implants after a mastectomy are not the same as a breast augmentation because all breast tissue would be removed. That would leave the implant to sit in the skin pocket she would leave behind. The plastic surgeon may remove skin if my goal is to have a smaller breast, but, ultimately it is just an implant and skin without surrounding tissue. There could be a possibility to do both implant and transplanted fat via liposuction, but that’s the plastic surgeon’s call. Doing that could help soften the sides of the breast and prevent puckering in the skin around the implant. A common complaint from patients.

I asked about using my own fat and tissue. Her answer was a bit more vague. Essentially the plastic surgeon would determine if I have enough fat in my belly or thighs in order to transplant it to make two breasts. There’s also “flap” procedure that would entail a tummy tuck, transplanting the removed skin to rebuild the breast and liposuction to transplant fat to the breast. Again, he would tell me if that’s possible.

I’ve never seriously considered a tummy tuck or “mommy makeover”. Not only is this not how I ever would’ve wanted it, but also, this is not the same.

I realized, she hadn’t mentioned anything about the nipples. I inquired if I’d be able to keep mine. She explained that she can only spare the skin. It’s up to the plastic surgeon to determine if he can spare the nipples. That may be based on current breast size, with a bias toward smaller breasts.

“Many patients live full and happy lives without nipples,” she said softly. “However, it’s understandable for your own mental health if you want them. Tattooing and prosthetics are also common in reconstruction. Tattooing has advanced significantly in the last few years.”

Shit. And more tears flowed.

Then more shit news followed. It was something that had never dawned on me. With a mastectomy, all of the nerves within each breast must be severed in order to “remove the pillow”. Therefore, I most likely won’t regain feeling in my breasts – even if nipples are spared. I may never feel hugs, hot/cold or intimacy in the same way ever again. She said many patients describe it as having foreign bodies on their chests and often get phantom sensations of what they used to feel.

“So. What’s it gonna be Nikki?” I thought to myself. “Fear breast cancer forever or voluntarily have your body maimed?”

I knew I would always fear cancer. No matter what I choose.

“I don’t want to go through this again.” I said. “I don’t trust my body to not create breast cancer again.”

She asked, “Ok, so do you want to schedule it as a mastectomy, but know you have the option to change your mind?”

“Yes.”

She walked through all of additional appointments that would be set. January 30th would be surgery day.

I felt sick.

She gave me a hug before she left the room, assuring me again that they’ll take good care of me.

Before I left, the nurse popped in one more time to take me to something called the SOZO machine, to have my lymphatic system checked for lymphedema. Then I walked back to the waiting room for my ultrasound.

The ultrasound results were good. No concerns in the left armpit. It’s just accessory breast tissue that changes with cyclical hormones. As uncomfortable as it is, it’s normal.

But nothing about any of this feels normal.