Just got back form Beth Israel.  It was a long appointment and we decided to make a day out of it.  We rode the bus to avoid the horrible traffic into the city and that was a great idea.  There is a Metro Station just a few blocks away and it was a gorgeous day so walking was very pleasant.  I first met with the radiation oncologist who examined me, went over my history and then left to meet with the rest of the time to have a tumor conference.  They gavea us a half hour break during which we took another walk.  When we came back, we met with the surgeon who also examined me and explained their impressions and reccomendations.  She said that because of the location of the tumor, it is likely that if they do a lumpectomy if the pathology shows the margins are not that clear, since it's very near the nipple they would then have to remove it.  For that reason she said, she'd reccomend doing a central lumpectomy in which they remove the nippple and areola right away rather than having a second surgery.  I could at a later date have it reconstructed.  The problem in my case is that since I don't have big breasts, they'd be removing like half a breast.  So I'm leaning towards mastectomy with immediate reconstruction.  I will be meeting with the plastic surgeon next week and at that time I could let him know of my decision so they can try to schedule me which is a little tricky since it requires coordinating both surgeon's schedules.  Since I'm having genetic counseling tomorrow, depending on the results, I might want to consider doing a prophilactic mastectomy on the other breast.  The doctor said this doesn't really increase by much the surgical time if I decided to do that.

After meeting with the surgeon I met with the medical Oncologist who said that if the pathology definitely proves the tumor is as small as it appears, I might be eligible for a trial of less aggresive chemo.  She also said that at that time they will perform a different test (a FISH test) for the Her2Neu since this one is much more sensitive and there might still be a chance that it would come back negative in which case I wouldn't have to take Herceptin for a year.

The other good news is that I was told that if I decide to go with a mastectomy it is very unlikely that I would have to have radiation.  Neither of the doctors felt anything in my lymph nodes and since the ultrasound found nothing they belive it's probably not going to be an issue.

I'm feeling very good about both my local Doctors and the Doctors at Beth Israel.  I'm especially happy that they all seem to be o.k. with collaborating with each other so if I have my surgery at Beth Israel, I can have the rest of my treatment here (which saves considerable time).  I'm very lucky to have all these wonderful resources so close by and that they are willing to work together.  I'm feeling very much at peace and well cared for.