Hi everyone,

Well, it certainly seems a long time ago that Bret and I came back from Maui! This terribly overdue blogpost is an update on where I am treatment wise. I realise that I haven’t put many medical details in my recent posts, and I know people have been curious about how things have been going and what the next stages of my treatment plan will entail. Also, sadly I have not had any further life enhancing encounters with turtles or any other creatures, seafaring or otherwise!

***SPOILER ALERT*** – Please be aware that this post includes gross descriptions of surgery.

I’m pleased to say that my operation in May went very well. When I met with my breast surgeon several months ago to discuss options, I was given the choice of having a ‘lumpectomy’ (having just the tumour and surrounding tissue removed), a single mastectomy, or a bilateral mastectomy. There really were a lot of factors to take into consideration with each of these options and I did a lot of research and soul-searching about what felt like the right choice for me. Ultimately, my surgeon and I both agreed that it would be prudent for me to have a single mastectomy, at the very least. There were a few reasons that we felt this would be appropriate over a lumpectomy. Firstly, if my surgeon were to do a lumpectomy and remove as much of the surrounding breast tissue as would be appropriate for my initial tumour size, I wouldn’t get a very pleasing cosmetic result. Secondly, if I were to do a lumpectomy I would have to follow that with 6-8 weeks of radiation therapy. I wanted to avoid that if possible because it would have permanently damaged my skin and also because I feel that as I’m only 30 I would like to limit my exposure to radiation at this time. Who knows if I might need to have radiation therapy at a later point in my life? Although obviously… I bloody well hope not!

The next decision to be made was whether or not I would just remove the right breast, or if I would remove both. It goes without saying that this was an incredibly hard decision for me and one that I spent a great deal of time contemplating. It was explained to me that if I were to remove my left breast, it would only reduce the chance of me developing a second breast cancer later in life; it would do nothing to lower the risk of my current cancer recurring. I did not test positive for the BRCA (breast cancer) gene, where a bilateral mastectomy would be considered necessary. However, having been diagnosed at only 29 years old, medically speaking I am a complete outlier. No one can explain why I might have got the cancer, and therefore what my chances might be of having a second (new) breast cancer at another point in time. I honestly felt like I couldn’t see my own situation reflected in any clinical studies or research articles that I found, and it is very unusual to get breast cancer so young and to not at least have the gene to explain it. At this point it’s worth noting that apparently most young women diagnosed with breast cancer opt for a bilateral mastectomy. Doctors believe that this is mainly due to the peace of mind many women feel at having their breast tissue removed, even when the statistics don’t necessarily show that much of a benefit. Again, my breast surgeon and I agreed that if I didn’t remove my left breast now, it would probably be sensible to do so at some point down the road, perhaps after I’d had children as with this course of action I’d still be able to breastfeed. I strongly considered this idea and for a while that was the road I thought I’d take. However, as I got closer to the surgery date, I just felt the decision wasn’t sitting right with me. I’m pretty distrustful of my body right now and to be honest I’m terrified of what might happen in the future. In the end, I decided that it didn’t make sense to hold on to the hope of being able to breastfeed, because really the important part is living long enough to get pregnant! So, I decided on a bilateral mastectomy with what is called ‘immediate reconstruction’. Admittedly, it’s not really all that immediate as it does require a minimum of 3 operations.

After deciding on my surgery plan, I was put in contact with a wonderful plastic surgeon to discuss all the reconstruction aspects. Again, there were so many choices to be made that I won’t bother detailing them all for you, but instead will just explain the process I am currently going through. Firstly, I had all of my breast tissue removed during my surgery in May. I was immensely lucky that due to the placement and size of my tumour, I was able to keep all of my skin and my nipples. My surgeons placed the two incisions in the natural creases underneath my breasts, which means that once they’ve healed they shouldn’t be too noticeable. It was from those 4 1/2 inch incisions that my surgeons then did all their work, which is incredibly impressive when you consider that breast tissue actually stretches all the way up to the collarbones and up to and slightly behind the armpits. I tried to find a photo on google to demonstrate the anatomy of breast tissue, but they were all pretty gross… do feel free to search this on your own time though! (Whilst you’re at it, search ‘surgical drains’ if you’d like a true sense of the hell I was in for two weeks following surgery. I felt like some kind of dystopian dairy cow!) After my breast surgeon removed the breast tissue and my sentinel nodes so that they could be biopsied, my plastic surgeon then attached temporary expander implants to my chest wall. These expander implants are slowly inflated over the course of several months by inserting a needle through the skin and into the expander to inject them with saline. I have already had two of these ‘boob pumping’ sessions and I can confirm it feels as weird as you’d expect. It’s as if I am a living balloon animal!

Once this process of expanding is complete, I will then have my second surgery which involves opening back up the original incisions and switching out the temporary expander ‘robo-boobs’, for some lovely less oddly-shaped silicone ones. At the same time I will also have some fat grafting, which is where fat is removed from another area of my body via liposuction and injected into the breast area. The reason for this is that without the natural breast tissue to cover the implants, they look a little unnaturally shaped and sometimes you can see the surface of the implants rippling. Finally, I will have a third surgery to have additional fat grafting, as often the fat from the previous session won’t have all stuck around. So, that’s the update on surgery… quite frankly, I’m exhausted just typing it!

The plan had always been that after my first surgery I would have 14 rounds of a drug called Herceptin. This drug has been painstakingly developed to specifically target the HER2 growth receptor that my cancer exhibits, therefore lowering risk of recurrence. However, after my surgery the pathology tests were re-run on the tumour that was remaining in the removed breast tissue. I’ve been told that my pathology results were very good, but unfortunately I did still have residual cancer left in the tumour bed. Having said that, the tumour had reduced from 3cm down to 0.5mm, so my oncologist was very pleased! Honestly, I had really been hoping for a complete response to the chemotherapy due to the fact that my cancer is aggressive and responds very well to chemo, so I won’t pretend that the pathology results weren’t a bit of a blow. On the other hand, this result does mean that I have access to a brand new state of the art drug, which is essentially Herceptin mixed with delicious chemotherapy. So, I’ll be having another 14 rounds of chemo over the next 9 months! This new chemo should be a walk in the park compared to the old one I had, as it doesn’t indiscriminately attack all the cells in the body like normal chemo, but only the cancer itself. (My chemo nurses jokingly refer to it as organic chemo!) I had my first round a few weeks ago and although I did get sick, it certainly was not as bad as regular chemo. So I’m holding out hope that I continue to do well on it and that I’m able to get through the next 13 rounds. Finally, the very good news was that my sentinel nodes were clear, so definitely no radiation therapy will be required and my recurrence risk should be a little less.

The final aspect of my treatment is to suppress my oestrogen levels for 5-10 years, hopefully taking a break at some point so that Bret and I can have a cute chubby baby. The reason for the hormone suppression is that my cancer feeds on oestrogen, so we’d like to cut off its food supply to make it much harder for it to grow back. As I am obviously pre-menopausal, this means I have to have monthly injections as well as take daily medication in order to keep my oestrogen levels low enough. I started this new regiment a few weeks ago, and so far it’s been manageable. My main complaints are joint pain and acne. Hopefully the acne will go away as my hormone levels settle down, and if the joint pain continues or worsens, there are different drugs that I can switch onto. I’m still trying to keep active though and have been doing short bursts of yoga at home to try and rebuild my strength from the absolute barrage of saviour poison I’ve endured.

And that’s all for now! Thanks again to everyone for their love and support. Bret and I couldn’t have got through the last 7 months without you all.

With love,

Emma xxx

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