6/20/19: Mammogram and Ultrasound - Inconclusive + NP Appointment

Today's appointment was scheduled because the MRI showed "something" in the left breast.

I thought they were going to do an ultrasound of my right breast, too, but they didn't. Maybe there's no need to look any further now that it's clear the right breast will be removed anyway.

In the waiting room, I was asked to fill out the standard mammogram paperwork again. This time, my answers included my recent MRI, biopsy, and breast cancer diagnosis. My NP popped in and said I could ask to speak with her at any time during my visit.

First, I got a diagnostic mammogram of my left breast.

Next, the ultrasound of my left breast. When the ultrasound technician left to show the images to the radiologist, the nurse who was at my biopsy came in. She was so comforting, I couldn't help a few tears from slipping out.

The technician and the radiologist returned. The radiologist was the same doctor who performed my biopsy. She said the technician didn't see anything in the ultrasound. She repeated the ultrasound herself to confirm the same.

So, neither the mammogram nor the ultrasound could explain what the MRI showed. The radiologist recommended an MRI-guided biopsy for my left breast, and also genetic testing. Before leaving, she gave me a kind, sympathetic, "I'm sorry you're going through this" kind of look.

At this point, my appointment was technically over, but I asked if I could speak with my NP.

I held it together until my NP walked into the examining room. She handed me some tissues and reassured me my reaction was normal. 

She said she is still in the process of making the appointment with the plastic surgeon.

She will make my appointment for the MRI with biopsy. That appointment would have to take place in the city. These appointments are typically made about 2 weeks in advance.

She will put in a referral for urgent genetic testing. They will call me to set up an appointment. 

She said genetic testing results typically take about a week. Even if the results aren't available in time for next Friday's appointment with the breast surgeon, we should still keep that appointment. 

We will proceed assuming both the biopsy and genetic testing are negative.

If the biopsy comes back as cancer, or if the genetic testing shows I carry genes linked to breast cancer, the surgeon would likely recommend bilateral surgery - a double mastectomy.

The NP said that even if both tests are negative, I should still think about whether or not I want to get both breasts removed. For some women, preserving natural breast tissue is very important. For others, reducing the anxiety of cancer recurrence is more important. If I decide to get a double mastectomy for preventative reasons, she would cancel the MRI biopsy, as the results would be irrelevant if the left breast is going to removed anyway.

I asked if there is any chance of recurrence if both breasts are removed? She said the goal is to remove all the breast tissue, but sometimes it's not possible, so there is a small 1-3% chance of recurrence even after a double mastectomy.

And how would I be screened for cancer, if there are no breasts to image? She said I would have regular clinical visits with her, the NP, and she would perform physical exams to feel for lumps. (I didn't think to ask, but will add to my list: Would breast reconstruction surgery affect the ability to palpably detect new lumps?)

Regarding breast reconstruction surgery, she said I don't need to decide that now. I can always choose to have it done at a later date. It was something of a relief to have one less thing to worry about right now.

To aid her in setting up my appointments, I had previously given her my summer vacation schedule. I told her to disregard them. I don't want to delay treatment.

5/16/19: NP Appointment

If you remember, I am actually writing these posts in retrospect. I am writing this post on June 15, and by now I have been to the Breast Center a number of times. I have to say, everyone I have interacted with at the Breast Center has been amazingly kind, professional, and helpful. You figure it probably takes a certain kind of person to work at a place where they mostly deal with patients who have or might have cancer. These are women who are all really good at their jobs, and I appreciate them so much.

So anyway. The Breast Center NP confirmed my two lumps are easily palpable. 

Regarding my first lump, she reassured me that sebaceous cysts can occur anywhere on the body, and I just happened to get one on my breast. 

She said the second lump felt similar to the first lump, but since we can't assume anything, we need to take the next step to figure out what the second lump is. After a mammogram and ultrasound, the next step is to get an MRI. 

The NP explained that MRIs require pre-authorization from my health insurance. The Breast Center would take care of obtaining that pre-authorization, which usually takes a few days. Then they would call me to set up the appointment.

She advised me to not bother with a dermatologist just yet. We would see what the MRI showed, and then go from there. 

5/13/19: Mammogram and Ultrasound - Inconclusive

At the Breast Imaging location, even though I had been told on the phone that a mammogram wouldn't be necessary (because one had already been performed on that breast within the last 3 months), while sitting in the waiting room, I was told that the radiologist wanted a diagnostic mammogram after all. This time, I definitely remember little stickers being placed on both the lumps.

Since my appointment had been scheduled as an ultrasound only, I guess having the mammogram first disrupted their schedule, because I had to wait a bit longer than usual for my ultrasound. 

The ultrasound technician (not the same person I saw at my first visit) looked at the first lump first, then looked around for the second lump. Curiously, she couldn't see the second lump on the ultrasound machine. She asked me to show her exactly where it was, and she spent quite a bit of timing looking for it, but she just couldn't see it on the machine. Eventually she gave up and left the room to confer with the radiologist. 

The technician and the radiologist (also not the same person I saw at my first visit) returned together. The radiologist, too, spent quite a bit of time looking for the second lump on the ultrasound, but couldn't see it. I really don't know how ultrasound technology works, but it seemed weird - and a little alarming - that the machine couldn't detect a mass that obviously existed and was easily palpable.

Anyway. The radiologist confirmed that the first lump was a sebaceous cyst, and she recommended I see a dermatologist, who might advise me on whether to leave it alone or get it removed. 

Regarding the second lump, the radiologist simply said that she was unable to see it. She said maybe the dermatologist could advise me on both lumps. I have to admit, this lack of information was troubling, and internally I was glad to know I had an NP appointment at the Breast Center coming up.