A Double Barrel Double Mastectomy

Since the recent news broke about supernova Hollywood star, Angelina Jolie’s double mastectomy, it has highlighted once again the importance of preventative care in the fight against breast cancer. Plastic Surgeon, Dr Willem Erasmus reports on the significance of early detection.
Hollywood actress, Angelina Jolie shocked the world in May this year when she announced she had a double mastectomy to prevent breast cancer.
She made the drastic decision after learning that she carries a mutation of the BRCA1 gene, which sharply increases her risk of developing breast and ovarian cancer.
According to the star, her lifetime risk of developing breast cancer before having her breasts surgically removed was 87%. Having the BRCA1 mutation also means a 50% lifetime risk of ovarian cancer.
Jolie’s mother, Marcheline Bertrand, died of ovarian cancer on January 27th, 2007 – therefore Jolie elected to have a double mastectomy to minimise her risk of breast cancer. She has also intimated that she may consider having her ovaries removed (Oophorectomy).
In an article in the Opinions section of the New York Times, titled “My Medical Choice”, Jolie writes about her mother who died of cancer at the age of 56 – and held out long enough to hold one of her grandchildren in her arms. Her other grandchildren will never have the opportunity to know her, she added.
Jolie emphasised that the risk of breast and/or ovarian cancer in women with the BRCA1 mutation varies from case to case – as soon as she realised what her odds were, Jolie decided to be proactive and reduce her risk to a minimum.

Jolie wrote:
“I made a decision to have a preventive double mastectomy. I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex. On April 27, I finished the three months of medical procedures that the mastectomies involved. During that time I have been able to keep this private and to carry on with my work.”
Early Detection is Key
A double mastectomy is no doubt a frightening prospect – even if the benefits are weighed up for high risk patients. However, be rest assured that there are alternatives.
One in ten women will develop breast cancer in their life, and the highest risk factor will be age.
Fortunately most of these will be detected early and treated effectively, but the key is to detect early – which is why it’s important for young girls to start self-exams from a young age. Ladies should also do it on the same day of the month post menopause, and a week after your menstrual cycle.
Just like brushing your teeth, divide each breast into quadrants and examine with your palm – feeling for any unusual lumps and bumps.
Additionally, women between the ages of 35-40 years should start considering mammograms and ultrasounds on an annual basis, and those that are at a higher risk, should start these examinations even earlier.

High risk means you have a positive family history – and the closer the relative, the higher the risk. If you have had a few close relatives who have developed breast cancer before the age of 60, then you should consider genetic testing for the BRCA 1/2 gene mutations.
BRCA gene mutations are fortunately rare (1 in 500), but the risk of developing breast cancer if you are positive is 50% – hence why Angelina Jolie opted for a double barrel removal. “My chances of developing breast cancer have dropped from 87% to under 5%,” Jolie said. “I can tell my children that they don’t need to fear they will lose me to breast cancer.”
Although the Oscar winning actress has been applauded and commended for her decision to have both breasts removed, a double mastectomy was not her only option. Remember, not everyone with the gene mutation automatically will develop cancer and not everyone needs to have a double mastectomy to prevent it.
However, increasing your surveillance by doing regular self-exams, ultra sounds or mammograms is of utmost importance.
Nine weeks after her mastectomy, Jolie had surgery to rebuild her breasts. She disclosed in the NY Times piece that she’d completed the reconstruction of her breasts with implants and is very pleased with the results.
It appears too that her physicians were able to save her nipples, a procedure that’s become available only recently, according to ABC News.
Implants are the most popular option when it comes to a breast reconstruction procedure – and it’s referred to as an Alloplastic Reconstruction.
However, they must be bigger than the usual breast augmentation implants because it has to compensate for the total lack of breast tissue. They’ll also weigh a lot more, which may be uncomfortable for certain patients.
Another option for breast augmentation is an Autologous Reconstruction i.e. your own tissues.
Most commonly we use fat and skin from a tummy tuck procedure – and use this to recreate a breast.
Lastly, for women who choose not to have surgical reconstruction, there’s always an option whereby one can wear a bra that is filled with an implant to give the impression of breasts, an option that we actually find to be not all that uncommon.
In light of August being Women’s Month, and the coming of October (Breast Cancer Awareness Month) – I urge all women to start self-examining early in your life and if you haven’t yet, then there’s no time like the present.
References: News Background on Angelina Jolie republished from Medical News Today

 Dr Willem Erasmus Written by A2 Expert Panel member: Dr Willem Erasmus MBChB FCS (SA)
Dr. Willem Erasmus is a Cape Town based Plastic Surgeon at RBSI – visit the website for more info www.plasticsurgeoncapetown.co.

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