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Adenoid Cystic Carcinoma Breast Tram Flap

Lori - May 30, 2009

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In autumn of 2007 during self-examination at 46 years old, I found an old familiar lump in my left breast had suddenly changed shape. It had been deep to the chest wall but within 2 months had headed towards the surface and was now visible to the naked eye. I had a mammogram 2 years prior where it was explained to me that I had very "cystic" breasts, which apparently make mammograms a less useful diagnostic tool. I had a needle biopsy done and braced myself for the results. The result came and not only was it cancer, but it was adenoid cystic carcinoma (ACC). This initially knocked me for a loop, but I sought and found strength in God who is always with me. Family and friends are His advocates. I proceeded with further tests to determine the extent of the disease. MRI revealed the left breast tumor in all its glory as well as a perfect sphere "undetermined" in the right lung.

I went online with my diagnosis as would most people these days and learned what I could. As breast cancers go I learned that 0.01% of all breast cancers are of this type. Not exactly the lottery win I was looking for. I had an oncology consultation within a month of diagnosis. I didn't know that I was going to be contradicting the doctor when he came into the exam room. He tried to tell me that he would setup a standard regimen of chemotherapy. I told him, "Doctor, I am certainly no expert on this; however, what little I do know is there's no specific chemotherapy for ACC of the breast." I made it clear that chemotherapy was not a good option for me. He was a little taken aback by this new patient of his. He didn't argue or agree with me.

I (along with my husband) had a consultation with the head of plastic surgery of the same hospital. He spent almost an hour explaining my options. He had a power point presentation that was most impressive and informative.

From the time of diagnosis to actual surgery was two months. I had a left mastectomy and excision of the right lung tumor AND reconstruction all at the same time. The surgeon got clear margins all around. YAY! Lymph nodes were taken and biopsied along with the right lung mass. It was 11-1/2 hours of surgery, but as it turns out it was the right thing to do. Thankfully the lymph nodes were clear, but the right lung mass turned out to be ACC as well. Not the news I was hoping for.

Part of the marathon surgery included about 5 hours of reconstruction. That involved a football-shaped incision from hip to hip for the purpose of harvesting belly fat to replace the mammary gland, a vein and artery to feed it and a skin flap to cover the wound. This was pure genius! I got a tummy tuck and a new boob all at the same time! I had no idea this was an option. It's all me, no implant to wear out or replace, no rejection. For anyone interested, or know someone who might be in the same situation the name of the surgery is called a Tram-Flap procedure. Just do a search online and you'll find info on it. The heal time is a little longer, but the long-term benefits make it worthwhile.

About a month following surgery I had my second follow-up with the oncologist who had changed his tune entirely. Thankfully he had the wisdom to conference my case with 15 other oncologists. 14 out of 15 oncologists agreed that NO chemo or radiation was indicated. That was a nice confirmation to hear indeed. My "treatment" would be (and has been) diagnostic tests. Thus far they have been negative. The last MRI in March 2009 should have put me on to annual testing, but the radiologist wants another one in six months "to be sure". I'm not going to read too much into that.

For a lousy circumstance I've have been so very blessed. The support I've received from family and friends has sometimes overwhelmed me to tears. The three surgeons who did their magic on me came highly recommended. They each lived up to their reputations and the care I've received thus far has been so much better than I expected. I've had no life-style changing chemo or radiation. You all know how these situations force us to focus on what's really important in life. I am no exception. I am grateful to wake every day and thank God for His many blessings.

May you know His blessings in your life.