Needles

 

I met with my oncologist Thursday morning. In a moment, I’m going to tell you about that. I also saw my plastic surgeon Wednesday afternoon, and had my first post-surgical saline  “fill”. I will discuss that after the oncology visit. I wanted to warn you about that now, though, because there will be images from that appointment. If you are uncomfortable with skin, boobs, or needles then you’re going to want to skip that part. However, if your hang-up is needles, just know that it’s only puncturing the skin, and beyond that it goes directly into the implant. I could not feel the needle, it’s really small, and it’s almost entirely in an inanimate object. I will share a pic of an unused tissue expander on a table before I share the procedure images, so if it’s too much for you that’s where you will want to stop scrolling.

At the oncology appointment, Dr. Joyce said that I will need chemo, radiation, and endocrine therapy “as we already know”. However, when I mentioned that the tumor board didn’t seem to think that it was entirely clear cut that I need chemo, she said that they are a highly respected board with many experts and if they think it’s possible that I don’t need chemo then we should look at things more carefully.

She considered me to be “high risk”, or possibly in a gray area, but she wants to do something called mammaprint testing to get a better idea of whether chemo will be beneficial.

According to breast cancer. org

https://www.breastcancer.org/symptoms/testing/types/mammaprint

“The MammaPrint test, made by Agendia, is a genomic test that analyzes the activity of certain genes in early-stage breast cancer.

Research suggests the MammaPrint test may eventually be widely used to help make treatment decisions based on the cancer's risk of coming back (recurrence) within 10 years after diagnosis.

Knowing if a woman has a high or low risk of early-stage breast cancer coming back might help women and their doctors decide if chemotherapy or other treatments to reduce risk after surgery are needed.”

What are genomic tests?

“Genomic tests analyze a sample of a cancer tumor to see how active certain genes are. The activity level of these genes affects the behavior of the cancer, including how likely it is to grow and spread. Genomic tests are used to help make decisions about whether more treatments after surgery would be beneficial.

While their names sound similar, genomic testing and genetic testing are very different.

Genetic testing is done on a sample of your blood, saliva, or other tissue and can tell if you have an abnormal change (also called a mutation) in a gene that is linked to a higher risk of breast cancer.” 

Who's eligible for the MammaPrint test?

“MammaPrint can only be used to analyze early-stage cancers. MammaPrint can be used on cancers that are:

• stage I or stage II
• invasive
• smaller than 5 centimeters
• in three or fewer lymph nodes
• hormone-receptor-positive and hormone-receptor-

How does the MammaPrint test work?

“The MammaPrint test looks at the activity of 70 genes and then calculates a recurrence score that is either low risk or high risk. If you decide to have the MammaPrint test, you and your doctor will consider a number of factors when deciding on whether to add chemotherapy to your treatment plan, including:

• your age
• the size of the cancer
• cancer grade
• whether cancer cells were found in nearby lymph nodes
• your general health”

So, Dr. Joyce has ordered this testing to get a better idea of whether or not it will be more beneficial to have chemo or not. Unfortunately, it normally  takes a couple of weeks for the results to come back and, since it’s a holiday week, it will likely take even longer. More waiting. More wondering. More worrying….

In the meantime, I still have a second opinion on Monday with a different oncologist. I did let them know that mammaprint testing has been ordered, in case he wanted to wait until the results are back, but they kept the appointment. I don’t know if that’s because he doesn’t feel like he needs those results to make a decision, or not. Regardless, all further treatments are on hold until this decision had been reached. 

If I do have chemo, it will be AC + T. I will get four doses of A and C, then 4 doses of T, and it will be done over the course of 14 weeks. You can look up the drugs if you want to. It’s a common regimen for breast cancer. But this is already a long post so I’m not going to dive into all of that.

Now, for the saline fill.

This is what a tissue expander looks like. The dark blob is the port, and that’s where the saline goes in. (If you’re creeped out by any of the stuff I mentioned earlier, here’s where you’re going to want to bail.)

First, a special magnet is used to locate the port, which is not visible from the outside. The green thing is the magnet. This does not contain a needle at all.

The magnet causes an indentation to appear on the skin so that the doctor knows where to place the needle. The faint + marks the spot.

Next, the doctor places the needle, then draws back to ensure it’s securely inside of the port. (The 2 red marks slightly above the needle are my biopsy scars. I thought they would be much worse!)

Finally, it’s time to start pushing the saline. The doctor pushes around on the skin as it fills to make sure that it’s not too much at once, and that proper capillary flow is maintained. It should turn white for a couple of seconds after he pokes the skin, then turn pink. If it doesn’t, we have to back off. I did not have any issues, though.

He was able to add 120 cc’s per side in this visit, and this is the final result of the first fill.

The couple of days since the procedure have been much more uncomfortable than the procedure, itself. There is a lot of soreness. The implant is hard, and awkward. It doesn’t really move, and it all feels very foreign (because it is). I think it will look ok, but I don’t think it’s going to feel much better until I can swap out for the silicone implants. That’s going to be pretty far into the future, though, so hopefully I will eventually get used to this. 

Whether or not I have chemo, I have to have radiation. I cannot start radiation until after chemo if that’s what’s decided, and I learned this week that I also can’t do radiation until after we’re done with saline fills. So, I will report back after my second opinion, but otherwise new information is probably going to be coming in slowly for the next few weeks.