The surgery aspect of breast cancer treatment is more complicated than you’d think. There are lots of different options for surgery. Some choices are better than others for recovery and quality of life later. Unfortunately, these are not all choices we, as cancer patients, get to make. The cancer makes some of these decisions for us ahead of time and our surgeons make most of the rest. The patient really only has the illusion of choice when it comes to surgical options. Then, there’s how much time off from work you need to heal, and whether or not that’s something you can afford to do.
When I first met with the surgeon, she asked if I had thoughts about what I wanted to do about the tumor in my breast. I told her that I wanted a double mastectomy. I didn’t want a breast cell left where cancer could grow back. Turns out there isn’t really a way to do that. There would still be breast cells within the skin tissue, so it’s not possible to get them all. But I don’t want to do this again.
A double mastectomy is a really big surgery. The recovery for that surgery is long and difficult. 12 weeks with a minimum of 5 days in ICU after the surgery while the recovery time for a partial mastectomy (lumpectomy) is 4-6 weeks with one overnight in the hospital. The kicker is that having a double mastectomy would only decrease my chances of recurrence by 2%. The math there seems simple. It’s a lot of extra pain, discomfort and time off work for only 2%.
Another thing not in my control is when I have the surgery. No one told me there was a very specific window for doing the surgery until the week before it was originally planned. So… I not only have to be done with chemo, my body has to have a chance to recover from chemo – all those issues with blood counts and skin infections came back to mind – and also be before the tumor has a chance to start growing again. Oh, and there’s no checkpoint in there to see if you’ve got a life alongside any of this. Cancer is more important than your quality of life.
Doing the Math and Counting Your Pennies
I have the fortune of being offered Short Term Disability (STD) leave for 90 days (6 weeks) per calendar year. While on this leave, I receive 80% of my current salary. After 90 days, it is Long Term Disability (LTD) leave, which is paid at 60% of current salary. For most people, myself included, a 40% reduction in salary is a pretty big dent. Honestly, a 20% decrease in salary’s a pretty sizable dent, too. Luckily, I also have the ability to work from home, which means that I can go back to work sooner. A lot of other people don’t have this luxury. I’m wondering what this would have been like if I’d still been a meter reader or worked somewhere doing physical things every day. I think I’d be screwed.
Seeing as I’m a single person living alone, I also have to carefully weigh how long I can afford to be away from work before it gets to be a significant financial burden to me. The answer is, not long. Part of that equation is also that I don’t have family living nearby, so I would need to either fly people in to help, and/or hire a nurse to come to my house and help with dressings and meals and whatnot. Plus I’d need to have someone come in to clean my house and help with laundry for at least 3-4 months post surgery. Yeah, that would all get really expensive really quickly.
Things to Know Ahead of Time
The oncologist and surgeon aren’t likely talking much before you’re done with chemo.
The new scans to determine whether or not the chemo is working will be done around 1 week before chemo is done. They won’t do them more than 2 weeks before chemo is finished.
There is a specific window for surgery after chemo is done. For me, it was 3-4 weeks post chemo. Why? First because the body needs time to recover its immunity and ability to clot after stopping chemo. Meaning that the white blood cell and platelet counts go back up. Secondly, for most of us, there is still live cancer in our bodies that they don’t want to start growing again after stopping chemo.
Bottom line – if you have something going on in your life around the time that you’re moving from chemo to surgery and on to radiation, about midway through the chemo is the time to start speaking up. If you’re lucky, the stars will align and you’ll still be able to do life things in between these stages. If not, well… there’s next year.