Over the past 6 months, Angelina Jolie has sparked incredible interest in preventative measures taken to combat breast cancer. After being tested for the BRCA breast cancer gene, Jolie opted to have prophylactic mastectomies (the removal of both breasts) to become a “previvor” of breast cancer. The term’s popularity is growing, due in part to the book Previvors: Facing the Breast Cancer Gene and Making Life-Changing Decisions by author Dina Roth Port. If you’re potentially prone to breast cancer, why wait to do something to fight it if you can prevent it?
Modern Options for Breast Reconstruction
What the “previvor” concept reflects is the many changes in choices women facing breast cancer, or the risk of it, have today as compared to only a few years ago. An important one is the availability of testing for the BRCA genes, which are actually mutations in genes that produce proteins that suppress abnormal cell growth (more on that below.) But perhaps equally important is the options available for breast reconstruction. With skin sparing mastectomy, the use of an internal bra made from acellular dermal matrix (such as Alloderm), and shaped implants, the entire procedure can often be done in one step with a short hospital stay. Aesthetic results are very good, often an improvement aesthetically. Trade-offs include the fact that even with nipple-sparing technique there will be loss of sensation, and although the risk is tremendously reduced, it is not zero.
What can a woman do?
Unfortunately, most breast cancers are not associated with the BRCA gene. Even with a positive test for the gene, a woman’s decisions as to what she should do about it are even less straightforward. My advice to a woman who tested positive would be, at minimum, to consult with a board certified plastic surgeon who will explain in depth the options for reconstruction. Nowadays, the options are robust and give an aesthetic so great that a woman may make the decision that so many have shied away from in the past with lesser techniques.