Wednesday, May 15, 2013

Angelina Jolie and Breast Cancer Reconstruction

I applaud Angelina Jolie's candid approach to her recent treatment for breast cancer.  Because of her “star” status, she is able to put a significant spotlight upon current issues in breast cancer treatment today.  This includes the BRCA gene, which places her at high risk for breast cancer, that many people may not know much about.   It also highlights her approach to this situation with her getting prophylactic bilateral mastectomies and immediate breast reconstruction with tissue expander implants.

Many people may wonder why someone would want to undergo bilateral mastectomies at this stage of her life while not actually having breast cancer but having a high risk gene.   She explains it quite well:  she wants to decrease her chances as best as possible, even at the cost of losing her breasts.   The complete removal of the breast tissue (mastectomy) early on decreases the chances for breast cancer significantly in the future.   In the meantime, she can undergo breast reconstruction which will still allow her to have excellent breast aesthetics.   By undergoing prophylactic mastectomy with nipple preservation, she will also avoid any radiation treatment which can severely deform the breasts--radiation has its own set of problems including wound issues, implant infections, contracture, radiation changes to the heart and lung.

 The other option that she may have considered is autologous breast reconstruction using her own tissues without an implant. This includes the DIEP breast flaps from her abdomen transplanted to her chest via microsurgical technique which would preserve her “super six pack.”   This would allow her to have breast reconstruction at the same time with her own tissues and would get a potential tummy tuck as well.    My guess is that Angelina Jolie did not have enough abdominal tissue to undergo bilateral breast reconstruction and that is why she chose tissue expander and implants.   She will need to undergo several expander injections and another operation for a final silicone implant.

 It is very common now for me to see patients who seek to undergo prophylactic mastectomies and immediate breast reconstruction.  It allows the patient to be treated at an earlier stage stage in a proactive way,  based on genetic information or early diagnosis.  Our team of breast surgeons, oncologists, pathologists, and plastic surgeons can treat women in the same, proactive way that Angelina Jolie sought with outstanding results.  

I thank and applaud Angelina Jolie’s courage in sharing this deep and personal part of her life to help others.   She is a super star in my book.


Holly Jahangiri said...

It's nice to see a doctor post this. I'm getting a bit tired of the way the media is second-guessing Jolie's choices about her own body.

I had Stage 0 DCIS and opted for bilateral mastectomy and immediate DIEP reconstruction (there IS an "upside" to having a little flab in middle age, after all!) I was much more afraid of the possibility of undergoing MORE surgery, radiation, and/or chemo later in life - when I'm not as healthy and strong and able to quickly recover. And, like Jolie, I didn't want to tell my kids that I was going to die of cancer. One less thing to worry about - and I'm happy about the decision.

But it's a personal choice, too - what's right for me may not be right for another woman at a different stage of her life. That's her call, and her doctor's - nobody else's. That's a conversation we ought to have, too.

Charles K. Lee, MD, FACS said...

Holly, thank you for sharing you personal experience regarding this and I also applaud you for your decision. It is never easy! and you are very right, no one choice is the right choice for everyone. That fact that you can have a choice is far better than having limited choices in more advanced stages of cancer.

Holly Jahangiri said...

Absolutely! Thank you, Dr. Lee. It's much easier when you have choices (and good advisers if you want them) than to have all that, and any sense of having control over your own fate, taken away.