At nine the next morning, I meet Herb at Dr. Luke’s. My breast, when Luke pulls out the sutures, has a thick pink scar, but I think I heal great. The problem is, I’m so frightened by what I’ve read in the medical books, I’m almost stuttering. When I tell Luke about my research, he is not happy. He knows some patients do this—lawyers, usually—but it’s not a great thing to do if you’re not a doctor because you can easily misinterpret things. I do not have inflammatory cancer. On the basis of size I have a stage-two cancer, but medullary is not the average breast cancer. I have, he repeats, a very favorable case.
We move on to the big decision: mastectomy or lumpectomy. I still don’t understand why one would decide about mastectomy before knowing if cancer is in the nodes. Luke says one has nothing to do with the other. Lymph-node dissection is diagnostic; it indicates whether the cancer has spread. Mastectomy or lumpectomy has to do with treating the breast and killing any remaining cancer. If the cancer had been found in a few places on the breast, a doctor would likely recommend mastectomy. If one is worried about recurrence, one might also.
Herb wants to know the statistics on recurrence. Luke says with lumpectomy, it’s 15 or 20 percent; with mastectomy, it’s down to 4 percent. My chances of getting cancer in the other breast is higher than other people’s, 7 percent for the next ten years, but Luke does not recommend a prophylactic mastectomy. He’s sending me for a mammogram, but he sees no indication of trouble in my right breast.
I want to know about reconstruction. Luke says at the time of the lymph-node surgery, he’d remove the breast tissue, leave most of the skin, but remove the nipple—it’s safer, because in one out of four times, the cancer is in the nipple. Then a plastic surgeon puts in an implant and constructs a new breast. It will look good, he says, but it won’t feel like a breast. It’s an artificial implant. I try to imagine what it will feel like. A contact lens which at first you are always aware of, then never feel? A football?
I am lost. I ask, since the cure rate is the same with mastectomy and lumpectomy, what the doctor recommends.
“I think mastectomy is the better treatment for you,” Luke says. “You’ve got difficult breasts, large, lumpy, and you’re worried about recurrence. Lumpectomy is for people who say, ‘I don’t want to lose the breast no matter what.’ That wasn’t your response. The only advantage of lumpectomy is that it preserves the breast. But it’s your decision.”
It is true, I think, that my first reaction was “Take off the breast”—but that was before I knew what reconstruction involved. Now I’m not certain. I ask Luke if, aside from statistics and my case, he has a personal bias. He says that he has had three medullary patients, and since one had a recurrence, he leans toward reconstruction. He also says that since he took so much tissue out of the breast, reconstruction will probably give me the better cosmetic result. I tell him I don’t think that will be a problem; my breasts are still the same size.
“That’s swelling from the surgery, and some pockets of air,” he says. “When it goes down, it may be much smaller.”
He suggests I talk to a plastic surgeon—there is one he thinks would be temperamentally suited for me, because he’s an artist and a doctor. I take this to mean that Luke is classifying me as a patient who is not so stable and is likely to cut off an ear or that he has been influenced by Herb’s beard, but I’m happy to be seeing the artist-doctor. Maybe when we get to his office, he’ll offer us an espresso. I haven’t had any breakfast. I could use it.
My mammogram, which we have taken across the street, is normal, except for what the report calls “a large radiolucency, in the left breast, consistent with residual air.” Apparently, Luke is right: My nice plump breast is pumped up like a Macy’s balloon and may deflate at any moment.
Then, in what’s turning into a cancer triathlon, Herb and I rush to the office of the plastic surgeon, Dr. Frank Veteran, in the Eighties, off Fifth. I’m a little worried about Herb. He’s the sort of man who feels uncomfortable in the lingerie department at Saks; I’m remembering photos of mastectomy from my medical books and wondering how graphic this consultation is going to get. But at the same time I’m excited. In the taxi, I have come up with a wonderful idea: Rather than mastectomy, why not, after treating my breast with radiation, do a reduction? If I get rid of, say, 30 percent of breast, I remove 30 percent of potentially dangerous, cancer-bearing tissue. I won’t have to run around nippleless or with a football in my chest. I could also end up with a very pretty pair of breasts. I do like my body, basically; there are times I look at myself naked and think I’m gorgeous, but as I’ve gotten older, or have seen skinny women with high little breasts at the gym, I have sometimes felt bad, looking at my sag, and wondered what it would be like to have a lift. I like Dr. Veteran, too. He’s not slick; there’s an air about him that suggests he has had personal experience with serious illness. Now, after Dr. Veteran examines me, I hit him with my idea. It’s original, all right—Veteran doesn’t know of anyone who’s done it—but he also says it’s not a good idea. Radiated tissue is difficult to work with: Some of the smaller blood vessels are destroyed; it doesn’t heal as well as normal skin. If one must operate on radiated tissue, one does, but he would prefer not to. Doing the reduction before the radiation is not a good idea, either. Reduction is major surgery; it takes time to heal, and that could delay radiation treatment. This is cancer; the medical considerations have to come first. My skin is good; I’m young; I can get “a very good cosmetic result” with reconstruction. The words “very good cosmetic result” disturb me. Is it a suggestion that I really could use a new pair? Is he saying, in a roundabout way, that what he has seen is awful? I have a sudden image of Joan Rivers, in an off-camera booth, feeding the surgeon lines. “She takes off her bra,” she says, “she could nurse SoHo.”