So the surgery plan is:
-sentinel lymph node biopsy
-remove my port.
The surgeon said her decision to recommend and feel sure that she can perform the lumpectomy was based on size. She will be taking out the 2 cm mass plus about 1 cm of normal tissue surrounding it, even though literature recommends as little as 2 mm. She also said that usually a lumpectomy can take out as much as ONE THIRD of the breast and still have it heal up pretty nicely. I think mine will be just under one fourth to one third. I guess.
However, she said with my radiation therapy, my breast will shrink a bit more. So all-in-all, I'll end up with a 1/2 cup to 1 cup size smaller. Which I'm honestly quite ok with. She said underneath clothes and everything, you can't really see a difference.
She explained the entire process for us. She will find the lump with sonogram and then insert a little wire that sticks out through the skin to mark it, and then she will remove the lump. It will take about 30-40 minutes to take it out. Actually the very first thing they will do is take me to radiology and do four quick injections of dye around my nipple (BLECK! THAT'S HORRIFYING! She said its unpleasant but quick. ug. But that I can request happy medicine beforehand to relieve anxiety. YES PLEASE!). The dye will drain into my lymph nodes just like the cancer would likely do and they will take out about 3 of those after they are done taking out the lump.
If those 3 nodes are free from cancer, then we are done. If all 3 have cancer in them, then she'll remove more. If there is just 1 or 2, research says that its ok and we don't need to take anymore out. There's no benefit in survival, because I will be getting radiation therapy later. And lymph nodes were not looking positive on my MRI imaging from before so that's a really good sign. So she is very hopeful that there will not be any involved nodes, but we just have to wait and see. Total, this will all take about 1 1/2 hours. Removing the port is super easy. They just open the incision, take it out, and that's done. Technically she could've done it right there in the office, but since we'll be in the surgery room, she will just wait. I should go home that day. I shouldn't have to have any drains, but they sent me home with a drain bag today just in case. That would be if they had to remove more than 3 lymph nodes. I'm supposed to pack an overnight bag too, just in case.
The lymph node incision will actually bother me the most because its connected to my muscle and range of arm movement area. I can resume normal activities pretty quickly, just don't do any bouncy like activities for awhile and avoid carrying/lifting things with my right arm. She said I could even go back to work on Monday, if I feel up to it. (I however have decided to take Friday off - for surgery obviously- and Monday and half a day on Tuesday, then I'll re-evaluate how I feel from there.) 3-4 weeks to heal fully.
I'm doing an MRI again next week to take one last look at the size of the mass, with clearer imaging, just to make sure there are no surprises before proceeding forward, but she doesn't expect there to be.
So what happens if there is not "clean margins" in the tissue they take off, meaning cancer cells in less than 2mm from the edge? She said if the mass was skewed and there were cancer cells located one edge with less than 2mm, they would go back in and do a re-excision to get that clean margin. However, if they take out the mass and the pathology report said that there are cancer or pre-cancer cells all throughout the edges of the tissue, then they would want to do a mastectomy, which she says is rare. Over 90% of the time, they get it all the first time. Because I have a solid tumor, as opposed to DCIS which is stage I pre-cancer, it is so easy to locate and take all of it out on the first try.
Then radiation therapy will start 3-4 weeks after surgery, so beginning of September. Chemotherapy is the hardest part. Surgery is irritating and there is some pain associated with it but its easy to recover from. She said radiation is very well tolerated by most women. So the HARD PART IS OVER!
The nurse came in later and gave us some paper work explaining logistics for the day of surgery. There was some question, which I'm still unclear on, whether I will be allowed to drive before they see me in my follow-up appointment. I THINK we figured out that its only if they have to send me home with drains. But I'm not sure yet. The reason why is because of the risk of getting into a car accident and smashing my chest into the steering wheel. That would be a very bad thing. So, I may be having to arrange hitching a ride with someone to work for a short bit.
But I'm so happy to hear this news today! SO SO SO happy!