If you follow me on Facebook or BlueSky, you might've seen that I've been posting pics from recent adventures in California's Sierra Nevada. The Sierra, of course, are the mountains that inspired the Whitefires in my Shattered Sigil trilogy, and oh gosh, how lovely it was to walk in them again. I do adore NZ's majestic Southern Alps, but the Sierra remain the mountains of my heart. There's just something about their jagged white granite silhouetted against indigo sky and reflected in turquoise lakes that never fails to exalt me and leave me in awe.
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| Our group rounding Royce Lake, high in the Sierra |
And boy did I need some exaltation. Earlier this year, I got some unwelcome news from yet another biopsy. I've got more very early stage breast cancer lurking in the same breast that had the lumpectomy 2 years ago. Like last time, it's contained in the duct and therefore not considered invasive (yet), but as this is the 2nd time around, the doctors want to be more aggressive. All at once, I was looking at a mastectomy, and trying to decide between a plethora of options. Single? Double? Reconstruction or not?
I'd always assumed that if more cancer was found, I'd just tell the doctors to chop both breasts off. I've never felt that breasts define me as a woman. Nor do I care how feminine I look, or how I fill out clothes. (I pretty much live in t-shirts and hiking pants.) Yet I do care about functionality of my body, and that brought a stumbling block I hadn't previously considered. Mastectomy means losing most sensation from the area due to severed nerves, even if you have reconstruction - unless you go to one of a very few surgeons that offer "resensation" nerve grafting, which is still rather experimental and has a relatively low success rate.
I found that sensation was actually important to me, and so I decided to do only a single mastectomy and keep the "healthy" breast, given that genetic testing found no evidence that I have any mutations relating to increased risk of cancer. That doesn't mean I don't have a bad gene lurking, since there's still plenty left for scientists to discover, but it makes it less likely. I'd learned that cancer-related decisions are all about weighing likelihoods and probabilities. There's no crystal ball, no way to obtain certainty about the future. As one doctor said to me, you just have to make the best decision you can with the information you have at the time.
So. Given that I decided to keep the healthy breast, I found symmetry was also important to me - not because of looks, but due to function. I didn't want to worry about muscle imbalances. Yet I also didn't want implants - I've known too many women who've had a lot of trouble with them, everything from painful capsular contracture to autoimmune issues. That led me to considering DIEP flap reconstruction. This is where a skilled microsurgeon takes a big ol' chunk of your abdominal fat & skin, reshapes it, and essentially transplants it up to the breast area. When it works, it works really well. The fat is still you, meaning real living tissue; it's pretty much the same as the fat that used to make up the breast. The downside is that the transplanting turns the mastectomy into seriously major surgery, with correspondingly higher risks. It means ten hours or more under anaesthesia, and a long, tough recovery thanks to a hip-to-hip abdominal incision.
The surgeons say I'm a good candidate. I'm "young" (in cancer terms, at least - I figure this is the last time in my life when I'll be told by multiple people how young I am!), and fit, and healthy apart from the abnormal cells lurking in my breast ducts. I've decided to go for DIEP, as it offers the chance of the best outcome. If I can slog my way up challenging passes in the Sierra, I can endure a tough recovery. (I hope!)
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| Climbing sandy slippery terrain toward an unnamed pass we nicknamed "Mordor Pass" |
Tomorrow is the big day. Single mastectomy plus immediate DIEP reconstruction is the plan. I'll be off work for two months to recover. Since I won't be able to do much exercise while healing, I figure it's a good opportunity to catch up on books, movies, and TV shows I haven't had time to enjoy. I've been asking friends for recommendations, and accumulated quite a list already, but I'm always open to more. If you have recs to share from the last few years, please do leave a comment or get in touch!
And cross your fingers for me. If I'm honest, I'm pretty scared they'll find the cancer has turned invasive when they do the pathology. But that's part of the future I can't control. All I can do is take one step at a time, and hope I will one day enjoy more moments like this:
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| Loving life on top of Feather Pass |
