Actress Angelina Jolie made headlines recently when she publicly announced in the New York Times her decision to undergo a double mastectomy procedure in spite of the fact that has not been diagnosed with breast cancer. The procedure is a preventative measure intended to pre-emptivley reduce the likelihood that she will face the deadly disease.
"I wanted to write this to tell other women that the decision to have a mastectomy was not easy. But it is one I am very happy that I made. My chances of developing breast cancer have dropped from 87 percent to under 5 percent. I can tell my children that they don’t need to fear they will lose me to breast cancer."
Jolie, whose own mother fought a long battle with cancer, had a genetic predisposition that put her at drastically heightened risk of eventually developing the disease herself. The procedure was undertaken to reassure her family and put her own mind at ease.
"My mother fought cancer for almost a decade and died at 56. She held out long enough to meet the first of her grandchildren and to hold them in her arms. But my other children will never have the chance to know her and experience how loving and gracious she was.
We often speak of “Mommy’s mommy,” and I find myself trying to explain the illness that took her away from us. They have asked if the same could happen to me. I have always told them not to worry, but the truth is I carry a “faulty” gene, BRCA1, which sharply increases my risk of developing breast cancer and ovarian cancer."
The doctors of Dunagan, Yates & Alison Plastic Surgery Center would like to take this opportunity to answer some common questions regarding preventative or prophylactic mastectomies.
When would a woman consider mastectomies if she doesn’t actually have cancer?
Some women who do not actually have breast cancer can benefit from what are called prophylactic (preventative) mastectomies if they have a very high risk of developing breast cancer. These women typically have a very strong history for breast cancer and may have been determined by testing to have a genetic predisposition for breast cancer, as was Angelina Jolie’s situation. Since there can be an extremely high risk of developing cancer, prophylactic mastectomies can be a life saving procedure.
If a women chooses to have prophylactic mastectomies, can she have reconstruction?
Yes. Just like a women who has mastectomies for cancer, women who have prophylactic mastectomies can have reconstruction. Typically this is done at the same time as the mastectomies (we call this an immediate reconstruction), and the reconstruction can be done with tissue expanders (silicone implants are later placed after the expanders are inflated to the desired size), or the reconstruction might use the patient’s own tissues, such as from the tummy. Either way, an immediate reconstruction is nice because it provides the patient with some breast volume right away, avoiding a completely flat appearance. An immediate reconstruction also lets us use more of the patient’s own tissues and arrange the scars more inconspicuously to give a more natural result. Also, an immediate reconstruction allows the reconstruction process to proceed more quickly.
Can the nipples be saved with this type of reconstruction?
Since prophylactic mastectomies are done before the cancer has occurred, it may be possible to save the nipples, either leaving them in place or by reattaching them to the lifted reconstructed breast. If we are able to do this, this can help provide an even more natural, esthetic result. The decision whether or not to save the nipples is made by the Patient, the General Surgeon, and the Plastic Surgeon.
What is the recovery like for mastectomies and reconstruction?
Typically, the patient stays 2-3 days in the hospital, and then recovers at home, being moderately uncomfortable for a few days. Most patients can drive after a week or two, and return to work after 2-3 weeks. After the initial reconstruction, the next operation (to take out the expanders and place implants, do nipple reconstruction, or to make other adjustments) takes place a few months later.