Hi friends,

Remember the Chinese farmer parable I shared a while back? For some reason I got ahead of myself with this surgery plan and the good news from the first surgery! I forgot about the principle the Chinese farmer taught me, and I should not have done that.

Surgery #2 was supposed to be the big one, single mastectomy with autologous reconstruction using a stacked PAP flap.

Let's just say it didn't go according to plan...

I woke up from surgery on Friday afternoon, after about a 6 hour surgery. I immediately noticed that I felt no pain in my legs at all, but I did feel pain in my right breast/armpit area. I was still very groggy so I thought, they must have used more numbing in that area.

Turns out, they didn't even touch my legs! So that's why they didn't hurt. 🫠

My surgeons found a tumor they weren't expecting when they removed the breast tissue. The MRI had shown a tumor in that location, but it seemed bigger to them and more unaffected by treatment.

All of that made them pivot into a direct-to-implant reconstruction in case I need to do radiation, or other treatment that might damage the skin and tissue in that area.

They were optimizing for preserving the flap tissue since I don't have a lot of donor sites to choose from, and once it's gone, it's gone.

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My poor mother

My mom was there in Austin with me for surgery and recovery, so she had to make the decision about what to do now that they had found something unexpected. She knew how much I didn't want implants but she also wanted me to have options once I woke up and might have to face further treatment.

I can only imagine how it felt to get this surprising bad news about your child, and in the same breath have to make a decision that you know won't make them happy.

She also had to tell me the news when I woke up. I don't remember the conversation but apparently I wasn't the most polite about the whole thing. 😅 My poor mother.

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Pathology came back 6 days later

They always run pathology on the tissue after a mastectomy, but in this case they focused extra on the surprise tumor.

My other tumors were Her2+ and the chemo regime I did was geared toward that. This tumor is triple negative, so much less likely to respond to that chemo, which explains why it looked the way it did.

I still don't know what this means for further treatment, since they tend to approach those two types differently, and my remaining immunotherapy was aimed at the Her2+ type.

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The good, the bad, and the unknown

The good: I handled 6 hours of anesthesia, breathing tube, etc well, and came out feeling ok. I was discharged from the hospital after just one night, and only needed Tylenol for pain.

With just the breast area to heal, my recovery has been much easier and faster.

Margins were clear! This is what you hope to hear in surgery and we got it. Margins were clear with plenty of room all around.

I got to fly home much earlier than planned. It was so great to be home with Daphne and Francois just a week after surgery. Of course I had made a super cool advent calendar with 23 gifts for D, so each day that I was gone she had something new to open. And now we didn't need it! So she started opening 2 per day and we still had some to open when I got home. 😂 The best laid plans...

The bad: They were not prepared to do implant reconstruction for me so they had to rush to find an implant that would work, and it's bigger than I would like. It feels very uncomfortable, and is bigger than my other breast. So as long as I have it I will feel self conscious about how it looks.

I still have to have the PAP flap reconstruction at some point. Once I know more about other treatment, I will be able to schedule that. It's a bummer to have to do another big long surgery and travel away from home and family again.

Triple negative is the most aggressive and scary type of breast cancer. The treatments for it are also very aggressive and scary. It's really not something anyone wants to hear.

Implants are inflammatory. During this time of recovery, and preventing recurrence, the last thing you want is something in your body that encourages inflammation. Sigh.

The unknown: I have no idea what comes next. I am working to get appointments with all my doctors this week to talk everything through, but honestly I don't think this situation is going to give me a black and white decision. I think it's going to be added risk with whatever choice I make.

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Choices I made and things I learned at this stage

1) I was unconscious so I didn't make any choices 😂. In all seriousness, this is why I'm so glad I chose the surgeons I did, and had my mom there who deeply understands my opinions on all of this. They were able to make the choice I would have made given the same set of information they had. 2) I learned, YET AGAIN, that nothing is given in this process, and nothing is certain. I wish I was better at letting go of plans and outcomes, but I'm still learning that. The hard way apparently.

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With love and gratitude,

Elizabeth