Pt 6: Michelle, My Cancer Concierge—Where’s the Champagne?

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Michelle, the Nurse Navigator was a wealth of information—so much more than I had gathered from Facebook or Google (who knew? 🤣)

Lesson #3: So Much More! 

  1. Understanding My Diagnosis:
    • 85% of breast cancer cases start in the milk ducts, and "invasive" means it’s beginning to move beyond that—hence, the term Invasive Ductal Carcinoma.
  2. Ruling Out the Spread:
    • While my pathology showed no angio-lymphatic invasion, I still needed two additional tests to confirm the cancer hadn’t traveled:
      • Axillary Ultrasound – scheduled for May 8th
      • MRI - scheduled for May 8th
      • Sentinel Lymph Node Biopsy – to be done during surgery
  3. Treatment Considerations:
    • Chemotherapy wasn’t needed before surgery, but my final pathology report could change that.
    • Radiation would only be necessary if I opted for a lumpectomy—which was a relief after worrying so much about both treatments.  Not doing radiation was something I could finally control and I knew I would not be doing the lumpectomy.  
  4. Surgery Options: 
    1. Lumpectomy - 
      • Removes the tumor and a small margin of surrounding healthy tissue while leaving most of the breast intact.
      • Radiation therapy is always required after a lumpectomy to reduce recurrence risk.
      • Yearly mammograms continue as part of monitoring
    2. Mastectomy - 
      • Unilateral (one) - the removal of the tissue in one breast and in some cases the nipple and areola 
      • Bilateral (two) - the removal of the tissue in both breasts and in some cases, the nipple and areola
  5. Reconstruction - for those choosing reconstruction, there are several approaches which come with unique considerations, including recovery time, cosmetic preferences and long-term impact on treatment: 
    1. No Reconstruction: Some patients opt to remain flat.
    2. Nipple-Sparing Mastectomy: Preserves the nipple and areola for a more natural appearance post-surgery.  A nipple-sparing mastectomy is not able to happen in all cases; it is dependent on the anatomy of the breast, nipple and areola.  
    3. Tissue Expander(s): Temporary implants used to stretch the skin in preparation for permanent reconstruction.  Every couple of weeks, saline is added to the expander until the patient is at the size they are trying to achieve.  Once there, the expander(s) is replaced with an implant. 
    4. Direct-to-Implant: Implants are placed immediately during the mastectomy, avoiding the need for expanders.
Beyond the axillary ultrasound to clinically rule out cancer in my lymph nodes, an MRI of both breasts to ensure no other tumors, genetic testing results and meeting with my Oncology Surgeon, the next stop was surgery—but deciding what type of surgery was still a major choice we had to make which is a deeply personal decision based on diagnosis (size, stage, grade), risk factors (genetic mutations) and personal preference.  


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