My “breast problems” actually started during puberty. A lifetime of hormone imbalance caused intermittent pain and swelling in my breasts: gynecomastia. Around 2007 I found my first lump in my left breast. The ensuing ultrasound and mammogram pointed to gynecomastia again and I went on a testosterone supplement to boost my testosterone/estrogen ratio. At the same time, my sister had gone through menopause and we compared our hormone levels: we were nearly identical! The testosterone supplement worked and I no longer had issues with gynecomastia, but I did have B-cup-sized breasts from a lifetime of excess estrogen.
Before COVID I had a trainer and was in excellent physical shape. I was a solid 190 pounds of muscle. I was in my fifties and taking no prescription medications of any type other than testosterone. During COVID, I gained around 35 pounds. At my 2023 April physical, I had high blood sugar, liver function issues, high cholesterol, and blood pressure. My doctor said unless I lost weight, I would need to take a whole bunch of prescription medications to control all these things, and worse, I would probably have a diabetes diagnosis within 3-6 months. We decided to roll the dice before stocking up my medicine cabinet and I started taking the semaglutide, Wegovy.
Over the next 90-days the pounds melted away. I lost a total of 40-pounds (yes, that’s half a pound a day). I was not as muscular as before, but happy to have shed the weight. In addition to the weight loss, my blood chemistry had completely returned to normal. The gamble worked!
Having just lost all that weight, I was lying in bed and noticed a clear crust had formed over my left nipple. No blood or scab, just a clear, dry, crusty covering over my nipple. I also noticed my nipple was oddly inverted. Cleaning off the crust, I noticed a hard lump under my nipple. Within a five-minute timespan, I knew I had breast cancer.
The next day I got a remote emergency appointment with my GP. He agreed that it had all the hallmarks of breast cancer: inverted nipple, lump, and discharge. He gave me an urgent referral for an ultrasound and mammogram. I was referred for tests at St. John’s in Santa Monica. The tests came back rated BI-RADS 5 – very likely cancer. I was looking at a Stage 1 or 2 breast cancer diagnosis based on the nurse practitioner’s experience, but probably Stage 2.
The following week I was biopsied. The full biopsy results showed I had Invasive Ductal Carcinoma. When I was told the diagnosis, everyone expected an emotional reaction from me. I didn’t have one. It might have been because I knew from finding the lump it was cancer and had prepared for and accepted this news already. It might have been because I was an engineer and I look at everything as a problem with potential solutions. I think the real reason was because 40 years earlier my mother was diagnosed with breast cancer. She fought valiantly but ultimately succumbed to the disease after four and half years. Before her death, I was terrified of dying. Watching and being with her to the end, I was no longer afraid of it. I had a sense of detachment from my diagnosis that allowed me to be calm and help those around me deal with it as well.
St. John’s did an MRI and the sight of the tumor on the film was disturbing. It looked like a spider had set up shop in my breast. It also looked bigger on the MRI than it felt. There was no evidence of lymph node involvement and it appeared to be less than 2 cm at its longest edge (with the scary tentacles going into the surrounding tissue). I wanted to get surgery ASAP, but the earliest they could get me in was about two weeks out.
Before surgery, I googled male mastectomy pictures and reconstruction. I don’t know how to say this and not offend someone, but the typical male mastectomy resulted in what I would call mutilation. While many men seemed to own their scars (or did not care), it wasn’t acceptable for me. I was thinking at the time that I’d have to find a plastic surgeon to do reconstruction after the mastectomy, and at my own cost.
I had my consultation with the surgeon at St. John’s, Dr. Grumley. She took pictures and moved my breasts around a bit. Then she explained she was going to do a double mastectomy so both sides would be balanced. For the nipple on the healthy side to be at the right height, she needed to remove it and graft it back on. On the diseased side, she was going to make a new nipple out of a small skin flap. I would be sewn up so that the scarring would be minimal and barely noticeable after healing.
I went into surgery and had my procedure done without incident. In addition to what I mentioned above, Dr. Grumley also made my areola on the healthy side smaller to look more masculine and natural. The only follow-up was a year post-surgery to get the areola and nipple on the cancer side tattooed to match the color on the healthy side. She also inserted two drains, but these would be taken out about a week post-surgery. I had no serious pain or discomfort post-surgery. When she removed the compress the day after surgery, I was shocked at how good a job Dr. Grumley had done.
When the big biopsy result came back, we discovered some good and bad news. The good news: I had a low Onco-score and wouldn’t need chemotherapy; it was a very slow-growing Grade 1 tumor. The bad news was that it had invaded one lymph node and the primary tumor covered a larger area than originally thought. All-in-all I got a Stage 2a diagnosis. They recommended that I get radiation therapy and take tamoxifen for five years.
I didn’t have any serious side effects from the radiation until the last few sessions when my chest finally swelled up and my skin “burned”. A few weeks later, I was completely back to normal (and the radiation had melted the scars on the cancer side away as well).
In addition to tamoxifen, I started taking a vitamin D supplement and received an infusion of Reclast, an osteoporosis medication that has shown some benefit in thwarting metastatic breast cancer spread.
About eight months into tamoxifen I started to have serious mental side-effects. I had a loud ringing in my ears, confusion, inability to focus, and short-term memory problems. I was taken off of it and placed on Astrozole, an aromatase inhibitor. I’ve recovered completely from the tamoxifen side effects and have had no new ones from the aromatase inhibitor.
Throughout this entire time, I’ve continued working with only some difficulty when the tamoxifen side effects got bad. I am at my one-year anniversary now and will get my nipple tattooed at the end of August 2024. These last two procedures will complete my reconstruction.
I’ll be watching the blood test levels mostly for signs things are moving in the wrong direction instead. I recall my mother’s blood tests after mastectomy kept rising linearly every six months until it passed the danger threshold. At that point, they took a closer look and the cancer had already spread everywhere. But it took a couple of years and it was slow and gradual. So, I will be vigilant but not let myself get too worried until there is a reason to worry!