I met with the Medical oncologist today. Lots of new information. At least I know what chemo's going to be like. I know I have a year of chemo ahead of me. It could be before and after surgery if I go with a lumpectomy or after surgery only if I decide I want a mastectomy. 

It seems like if I decide to go with a mastectomy, it would be best to do it at Beth Israel since they do state of the art DIEP reconstruction. It's a much longer surgery than the tram flap but it doesn't involve your abdominal muscles and it looks and feels more like a natural breast (they say). Since I will be meeting with the whole breast cancer team at Beth Israel next week and the pastic surgeon there the week after, I will by then have a better idea of what the chances are for a lumpectomy to be succesful and what everyone believes would be my best option. Neither procedure makes a difference in terms of prognosis.

The issues with the lumpectomy are in the first place how likely will it be that I won't need additional surgery and in the second place,  given where the tumor is located, how likely will it be that it will be cosmetically succesful. I also have some concerns about the secondary effects of radiation since it's my left breast and my heart would be getting some radiation which slightly increases the risk of cardiovascular disease which is prevalent in my family.

If I had a mastectomy I might still have to have radiation if they found something in the lymph nodes so we are trying to figure out if we can do a sentinel lymph node biopsy ahead of time to figure out if ther's anything there. Tomorrow I will be meeting the Plastic Surgeon here to talk about the procedure he does. Next week I get my second opinion, genetic counseling, and I meet with the radiation oncologist here.  Maybe I should pitch a tent in the hospital parking lot. Will keep you posted