Angelina Jolie made headlines two years ago when she revealed she had undergone a bilateral prophylactic mastectomy (preventive double mastectomy) after learning that she carried a mutation on the BRCA1 gene that gave her an estimated 87 percent risk of breast cancer. With fearless candor, she recalled the physical and emotional struggle she faced before and after the procedure. Her confession had other cancer-free women with similar gene mutations wondering: Is that the right decision for me, too?
Before you undertake this critical decision, inform yourself on the process of having a preventive mastectomy:
1. Mast: Option
Who should consider a preventive mastectomy?
There is no one-answer-fits-all approach to determining who should have a preventive mastectomy. Testing positive for an abnormal BCRA1, BCRA2 or PALB2 gene means you have a much higher risk of developing breast cancer over the course of your lifetime. Knowing this gives you several options: cancer surveillance, chemoprevention or a prophylactic (preventive) mastectomy. Surveillance means carefully monitoring symptoms of breast cancer; chemoprevention involves medication to reduce the risk of developing breast cancer; and a preventative double mastectomy involves removing both of your breasts.
A prophylactic mastectomy can reduce the risk of developing breast cancer by 90 percent. However, it is a serious, irreversible decision that can have considerable impact upon your life, and it is important not to make a fear-driven decision. Consult with your doctor and loved ones to determine how best to address your personal situation.
2. Mast: Recovery + Wound Care
How long will it take to recover?
As with any other surgery, your body will need time to heal. Hospital stays average three days or less, and at-home recovery can about three to six weeks, according to BreastCancer.org. The day after your surgery, a medical professional will likely teach you an exercise routine that helps prevent arm and shoulder stiffness and prevents the formation of significant scar tissue. You will also be instructed on the proper pain medications, how to care for the dressing over your incision(s), and how to care for a surgical drain.
From a practical standpoint, make sure you have plenty of friends and family on board to help with meals, laundry, shopping, childcare, etc. Many women who have had mastectomies also recommend stocking up on oversized button-down shirts (brilliant!), body pillows, electric toothbrushes, as you will have limited arm motion, and dry shampoo, as showering may be difficult or impossible in the days following the surgery.
3. Mast: Breast Reconstruction
Can I have a breast reconstruction?
Yes. Women can choose to have breast reconstruction performed immediately after their mastectomy or in the months and years following the surgery. Some women may have concerns over their nipples and areolas, however options do exist to leave them intact — although, you may not experience a full return of erogenous sensation.
Angelina Jolie wrote of her decision to undergo a procedure called a "nipple delay." Essentially, the nipple-saving step involves severing the blood vessels and breast tissue beneath the nipple so it no longer depends upon the underlying tissue for blood supply. It then becomes used to getting blood from the skin surrounding it. As Jolie wrote, it causes pain and bruising, but it increases the chance of saving the nipple.
Women also have the option of undergoing a nipple-sparing technique during the mastectomy. Essentially, doctors make a small incision around the areola, and remove cancerous breast tissue through the incision. They create a natural skin envelope that can be filled with a breast implant or tissue from another part of the body.
4. Mast: Emotional Recovery
Will it be emotionally difficult?
The emotional process of deciding to get a mastectomy and getting a mastectomy can be incredibly painful for women. You may feel that you've lost a part of yourself. You may not feel sexy. You may suffer from low self-esteem. You will not be able to breastfeed, which can be extremely emotionally distressing for women who plan to have children. You may miss your breasts, and feel guilty for doing so, because you are lucky enough to be cancer-free and alive.
All of these feelings are completely normal. It's okay to mourn the loss of your breasts.
Before you make a decision that could change your life, take the time to consult with your friends, your family, your loved one, your doctor, and most important, yourself.