Well, I have been diagnosed with my second local recurrence of breast cancer. This time it involves my chest wall, through the rib cage towards the pleura and is situated underneath my DIEP reconstruction which I had done in 2005, eighteen months after my original mastectomy. My first local recurrence was eighteen months ago and in the area of my original tumour, situated underneath the skin and into my reconstruction.

I have had to push quite hard for this recent diagnosis and had to be quite stubborn – having been told I had “fat necrosis” from my surgery last year. I knew it wasn’t. Anyway, once it was established that it was cancer again, it was the usual bone scan, CT scan, MRI scan to see what is going on and where. Amazingly the results show that it is, once again, a local recurrence with no distant macroscopic spread on bone or CT scan but it is extensive. It is suggested to me that I may be eligible for a chest wall resection – either that or my other option is to go straight into long-term chemo that could manage my disease for a good number of years. Hmm, I don’t relish the thought of long-term chemo, neither do I relish the thought of more surgery – I’ve had more than my fair share over the years. The other words that stick in my mind is that the chest wall surgery is my only chance to get back to NED once again.

It is explained that it is a huge operation and would involve my breast surgeon and my plastic surgeon travelling to a cardiothoracic surgery centre to operate together with a cardiothoracic surgeon. It is not to be undertaken lightly but it is an option. I agree, in principal, to consider it, although I find it all very scary. I am told that the first step is to have a PET CT scan – this is a CT scan with a difference, you are injected with radioactive glucose which is taken up by fast-growing cells (mostly cancer cells) which will shine up on the scan to highlight areas of active cancer – including any microscopic areas not previously visible on CT scan – so, for example, if there was evidence of microscopic cancer activity in the liver or any lymph nodes it wouldn’t be viable to undergo such major surgery. The PET
scan isn’t available at my local hospital so I had to travel quite a distance to have this done.

PET results show that I have no evidence of any microscopic activity and the only cancer activity is that known about over my rib cage.

I meet with breast surgeon and plastic surgeon who agree to take on my case in principal and I am referred to a cardiothoracic surgeon, specialising in cardiothoracic oncology, at a regional cardiothoracic centre of excellence.

When I meet with him he tells me that this is a HUGE operation which, in itself, could kill me. He can’t give me statistics as every operation is bespoke to each person. I understand that he has carried out around 15 such ops in the past 5 years or so. He does say that he can’t really tell me what he is going to do exactly as he doesn’t know until he gets “in there”. I am given lung function tests, carotid artery ultrasound tests and I have two days to make up my mind for surgery the following week. He did say that there is some evidence that surgically de-bulking large tumours is helpful for long-term outcomes.

I must admit that my mind was whirling and the only thing I can compare that decision making with was Russian Roulette – with a spinning gun chamber with a single bullet – held to my head – am I brave enough to pull the trigger??? I finally decided that this bloody cancer is going to get me one way or another – this is a chance I have been given and I decide to take it – if I die under the anaesthetic I won’t know about it anyway!!

So I agreed to surgery. When I sign the consent form it lists infection, scarring, pneumothorax, multi-organ failure and death as complications!! As I understand it, they are going to remove my sternum,

half of my rib cage on one side, my DIEP reconstruction and all the overlying skin. The ribcage etc is to be replaced with mesh and a skin flap is to be taken from my thigh (ALT flap) to cover the recon and skin that is being removed.

I was admitted the day prior to surgery and it is explained that surgery will commence at 8am and will take “as long as it takes”, at least the whole day. I will be in intensive care for as long as necessary and then be returned to a high dependency bay on the cardiothoracic ward.

The anaesthetist explained that I would have an epidural anaesthetic in situ for the first few days and then this would be weaned off. I was also given a pretty hefty pre-med sedation – the first time I cannot recall anything from changing into op gear – perhaps they were afraid that I might change my mind at the last minute!!!

My next memories are of being in ICU the following day on a ventilator – I was finally transferred to the HDU in the early afternoon of the day after my surgery. The first few days were a haze of snoozing through a hefty anaesthetic and painkillers – on bed rest and struggling to simply stay awake.

I had my operation on a Wednesday and was on bed rest until Saturday afternoon, when I was allowed to sit out in a chair for the first time. On the Sunday they started weaning off the epidural and on the Monday I was allowed to have a shower and mobilise a little. I had a large thoracic chest drain in after surgery, together with two smaller drains, one under my skin flap on my chest and on from my thigh where the skin flap had been taken from. These were removed on the Monday after surgery as they were no longer draining any significant amounts.

I had daily chest X-rays to check the status of my lungs, in particular checking for fluid and/or pneumothorax. I had physiotherapy to inflate my lungs and the usual leg/arm physio for my flap surgery.

I made good progress and having initially been told that I would be in hospital for ten to fourteen days, I was discharged home on the Wednesday, one week after my surgery.

To date (two and a half weeks post op), I am making good progress. Histology has shown good results on three sides but some evidence of microscopic cells under the skin along the upper edge of the surgery. There was no evidence of invasion into my pleura (which was uncertain prior to surgery) and a suspicious are in the upper lobe of my lung that was highlighted on scans was biopsied during surgery and has proved to be benign. I am awaiting news of chemotherapy – it is thought I am likely to have a course of Xeloda.

Pain wise – things are pretty good – I am feeling better every day – initially I felt as if I had been hit by a bus but I am noticing a good improvement. Pain relief at present is Paracetamol and Codeine and this is working well. Coughing and sneezing are NOT good – best avoided if at all possible!!!

All in all, the surgery was very tough – far tougher than anything I’ve had before – as my breast surgeon said at my check up last week – you can’t get more extreme surgery than that!! Now he tells me! Would I make the same decision with hindsight??? Yes, I think I would – it was an opportunity and I had to take it. I know that I am a pretty tough old bird but I was well prepared and didn’t come up against anything unexpected.

The ward that I was in was mainly patients with primary lung cancer, some with secondary lung cancers and I found it to be quite a humbling experience as many patients were in a very different position to myself which, once again, made me focus on my “good fortune”.

Of course, it leaves me back in the situation of a flat chest wall as in the case of my original mastectomy and I have lost my beloved reconstruction but I realise that this is my situation now as we need to monitor the area carefully in the future – hopefully I will come to terms with that.