Breast cancer patient grateful for second opinion
Debbie Galvin couldn't have guessed a breast cancer diagnosis would result in breasts she actually liked.
She had never been much of a breasts fan. Hers were large and heavy.
But when she discovered a lump on Easter Sunday and was told just over a week later that she needed a double mastectomy, Galvin wasn't quite ready to give her breasts up. She decided to seek a second opinion before having them removed.
Instead of going through with the course her first provider recommended, she decided to undergo treatment at the UF Health Breast Center – Jacksonville.
Months later, Galvin is undergoing chemotherapy, preparing for radiation therapy and ready to take on the world. She’s also very pleased with the breasts she ended up with after a lumpectomy and breast reduction.
Galvin learned that every patient’s cancer is different and every treatment plan should be different, too.
This is her story.
Finding the Lump
Debbie Galvin stepped out of the shower in a hurry to begin Easter Sunday festivities when her wrist brushed against her breast.
"I felt something different that I hadn’t felt before," she recalls. "It was a lump."
The next day she was in her OB/GYN’s office, and the day after that she had a diagnostic mammogram. She heard the words she had dreaded: breast cancer.
"I started to cry. I thought I couldn’t survive it," she says. Then came the even harder part: breaking the news to her parents.
Just over a week later, her doctors recommended a double mastectomy as soon as possible. They scheduled the surgery for a few days later. But something didn’t seem right.
"It all happened so quickly and it seemed so radical. There was no conversation and it almost seemed mechanical. Like, this is the walk that every patient walks," Galvin said. "I thought, 'No, this is about me.'"
Seeking a Second Opinion
Galvin’s decision to seek a second opinion started with a text message to a dear friend of hers, John Murray, MD, an assistant professor in plastic surgery at the University of Florida College of Medicine – Jacksonville. Murray saw many women in his own family struggle with breast cancer and he is passionate about treating breast cancer patients. He urged Galvin to meet the UF Health Breast Center team before going through with her surgery.
Breast surgery chief Laila Samiian, MD, FACS, changed everything when she told Galvin, "This is not what you’re going to die from."
One of just two fellowship-trained breast surgeons in the region, Samiian took a purple pen and marked where the lump was on Galvin's breast. Then Murray pulled out a sheet of paper and started drawing examples of how Galvin's breasts could be reshaped depending on the size of the lump. Galvin just watched in amazement.
"It was almost as if they were in the operating room discussing what the plan was. I thought wow, this is teamwork."
Galvin and her husband Tim had a number of discussions with the team and together they all decided that a lumpectomy and breast reduction would be the best course. The lump was small enough, and Galvin’s breasts were large enough, that the cancer could be removed without mastectomies.
"A lot of people are encouraged to have double mastectomies, but she was good to get a second opinion," Samiian said. "We planned it so carefully to make sure the chance of success was more than 90 percent. A double mastectomy wouldn’t have given her any better odds."
Galvin was happy with the new plan. She had been uncomfortable with the plan to have a double mastectomy followed by breast implants because she didn’t want anything she considered foreign added to her body.
"It's not possible in every woman, but technologies have improved so much that I think we'll be seeing more of these types of procedures in the future," Murray explained.
This time, Galvin said she and her husband felt confident in the course she was about to take.
"We really felt like we knew what was going on at every step and we were included in the decision," she said. "They were always right there. They made me feel like they were my team and I was their only patient."
Preparing for a Lumpectomy
Galvin's lumpectomy was extremely precise thanks to a relatively new technique called radioactive seed localization aided by high-tech 3-D mammography. The UF Health Breast Center is the only facility in Northeast Florida capable of the 3-D digital imaging, called tomosynthesis.
First, Martha Wasserman, MD, assistant professor of radiology and chief of women's imaging, took biopsies of Galvin's breast, choosing the sites based on the 3-D images and using a needle to leave a small marker behind at each biopsy site. After pathologists determined which biopsies were cancerous, Wasserman used a needle to place tiny, sealed radioactive seeds a safe distance around the margins of the cancerous lump.
The seeds can be put into place days in advance of a surgery, which makes the process much more manageable for both patient and doctor. If they don’t have access to radioactive seeds, radiologists have to use wires to mark the margins. The wires are inserted into the breast a few hours before surgery, poking out of the skin for the duration of the procedure.
Just before she went into surgery, Galvin remembers Murray telling her, "Deb, this is the day we separate you from cancer."
His words would stay with her, reminding her when she woke from surgery that from this point on, breast cancer was merely a part of her past.
In the operating room, Samiian used ultrasound equipment and a handheld device designed to detect the radioactive seeds. She removed a mass of tissue that contained the entire lump plus a safe margin of healthy breast tissue around it, using the seeds as her guide.
Once the lump was removed, Wasserman took images of the breast tissue using the 3-D mammography machine. She compared the lump to her images of the lump when it was a part of Galvin's body, making sure they were identical and that the entire lump had been removed.
"The technology today is just amazing," said Wasserman, whose own mother battled breast cancer years ago.
Galvin's breast tissue was also immediately examined by pathologist Anwer Siddiqi, MD, associate professor of pathology, who ensured that the cancerous cells he expected to see were all within the tissue. Removing all the cancer in the first surgery is critical because it would be extremely difficult to find the same space if a second surgery were required, Samiian explained.
While Galvin was under anesthesia, she also had a sentinel node biopsy, something Samiian said all patients with invasive breast cancer should have. Sentinel nodes are the first lymph nodes breast cancer spreads to. Siddiqi found that all three of Galvin’s sentinel nodes were cancerous, so Samiian removed the 30 remaining accessible lymph nodes in Galvin’s underarm. Six of those nodes also tested positive for cancer.
Samiian said having the pathologist, radiologist and plastic surgeon working with her during the surgery was critical to the operation's success.
"It takes extra effort to do something like this. If you’re not in a multidisciplinary group like we are, it would be so hard to coordinate everything," she said.
Once the team confirmed the lump was completely removed, it was time for Murray to reshape Galvin’s breasts.
"After a lumpectomy, a woman will have a very distorted breast," Murray said. "So what I do is all about quality of life. It adds to the feminine sense of self and self-esteem."
He worked to match the size of the breasts and raised the nipples to give them a natural look.
"I often tell my patients, it will never be what God gave them, but what God gave them was going to kill them. They won’t get perfection, but it’s an excellent substitute for what was removed from them," Murray said.
The Next Steps
After her surgery, Galvin's story was far from over. She would return for regular checkups with the breast center team as she healed. Next, she would need chemotherapy treatments and then radiation therapy.
She hopes to receive proton therapy, which aims proton beams on a specific location so there is less damage to surrounding healthy tissue. Located on the UF Health Jacksonville campus, the UF Proton Therapy Institute is one of just a few places in the nation offering that type of treatment for breast cancer. Researchers believe it could counter the prevalence of heart disease in women who have traditional radiation on their left breast, which is right above the heart.
Galvin’s ongoing need for treatment doesn’t mean life has to stop.
Samiian advised her to see UF Health psychologist Sarah Osian, PhD, who soon became an important part of Galvin’s healing. Osian asked Galvin what goals she wanted to accomplish during her recovery, which was refreshing to the patient.
"It's a fight for your life, but why fight for your life if you’re not living your life?" Galvin said.
As she continues to undergo her chemotherapy treatments, Galvin said she feels like she can take on anything now.
"I’ve had the biggest scare of my life. I don’t think anything else can scare me," she said. "I realize now anything is possible."
And as for her breasts?
"That’s the silver lining in it all. I’m 55, but they’re the breasts of a 21-year-old," she said. "Dr. Murray said he was going to give me perky breasts and I thought, 'Yeah, right.' But guess what? They’re perky."
When other women who are diagnosed with breast cancer ask her for advice, she answers carefully because she knows each woman’s experience will be completely unique. One recommendation she can always share, though, is to go to the UF Health Breast Center.
"I feel like my breast cancer treatment was designed and personalized for me. Everyone’s journey is different, and I know they don’t tell each person the same story."