Medical choices

Choosing a specialist in a foreign country is difficult. Before being diagnosed with cancer I knew very little about the UK health system but wanted to make sure I made the right choices for me. I wanted to choose a good specialist and a good hospital. I did some research online and when I came across the profile of my current breast surgeon/surgical oncologist I knew I wanted to be his patient. Going to the doctor has always been something I disliked, very often I don’t feel comfortable so having someone I trusted was essential.

He is one of the pioneers in sentinel lymph node biopsy and the first surgeon in the UK to perform endoscopic mastectomies. I like innovative and skilled people. An endoscopic mastectomy is performed by making a small opening around the axilla through which surgery on the armpit can also be performed (sentinel lymph node biopsy). A small camera is then placed through this opening and the operation is performed under direct vision. The breast tissue is removed via a scar around the areola of the breast. The advantage of this procedure is that there is minimal scarring on the breast with a potentially better cosmetic outcome. However, this procedure is only suitable for patients who have early breast cancer and who have small size breasts (cup A or B), like me. This type of surgery not only leaves minimal scarring but also spares the breast tissue and the nipple.

It took me some time to decide on the type of surgery, but once I did, I had no doubts it was what I wanted. I was very happy with the results and I wish more women could have access to the same type of surgery. Unfortunately in my case I needed a second surgery to clear the margins which meant removing the nipple. After the first surgery, the lab tests done to the tissue removed raised doubts whether the margins were clear. Almost without hesitating I agreed with the doctor to have a second surgery to clear the margins. The original tumour was too close to the nipple and because I have small breasts and not much fat, it was a safer option to remove it.

I chose not to have immediate reconstruction because I knew I was going to have radiotherapy, which may affect the skin and the implant. Sometimes I consider not having reconstruction at all. I feel good about the way I look now and I am afraid that the reconstruction will not meet my expectations. There is a chance I will need to remove the other breast because of the type of cancer I have and the increased chances of having recurrent cancer, and in that case I will definitely have reconstruction. I have finally the chance to upgrade my mosquito bites into Bombay mangoes and even so I am pretty sure I will go for the same model, to make me feel like the old me. But that is something to consider next year: first chemotherapy, then radiotherapy, then eventually another mastectomy and reconstruction. One thing at the time.

Before I was diagnosed, I hardly knew anything about cancer. To start with I had no idea that it could affect my fertility and that I would be under treatments for at least 5 years. Another important medical decision we had to make was whether to have fertility treatment to allow us to freeze some embryos or not. Following my surgeon suggestion and after doing some research, I chose an oncologist who is very active in clinical trials and has a particular interest in young women with breast cancer and fertility related issues. She had no objection to having one round of fertility treatment, so after long consideration and a lot of tears, we decided to go ahead. I am aware that my chances of ever becoming a biological mother are extremely slim, I will most likely never have children, but I want to feel like I am doing all I can to leave as many doors open as possible. It is hard to explain why I want to have a family, but I think it would make me happy and that is enough for me.

With chemotherapy I wasn’t given much of a choice. I could have refused treatment but that only crossed my mind after I realised how hard the treatment is. And even when I am at my lowest wishing I didn’t have to have chemo ever again, I know it is for my own good.

Making choices in difficult situations is not always easy, specially when you don’t feel you are in control of the situation.