Orlando Sentinel Article on Mastectomy and Reconstruction

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Wed, 10/23/2013

Orlando Sentinel

The Front Burner: Pre-emptive operations can bring peace of

mind

By Jeffrey Hartog Guest columnist

October 18, 2013

It's certainly not always an easy choice for a woman to make, but in my experience with

women who choose to have a prophylactic (pre-emptive) mastectomy, it brings a level of

comfort and peace of mind to an otherwise highly stressful situation. Women who make this decision

usually do so because of a significant family history of breast cancer, a prior breast cancer condition of their

own, or a positive breast cancer (BRCA) gene test.

One of my patients for breast reconstruction, Dr. Julie Miller, agreed to share her personal story to explain

how and why she made the decision to have a pre-emptive double mastectomy.

She's a radiologist at the Women's Center for Radiology in Orlando, so she is not a typical patient when it

comes to her knowledge of breast cancer issues. The major motivating factor in making her decision to have

a double mastectomy was her mother's death. Her mother had breast cancer decades earlier and felt

disfigured by her mastectomy (though subsequent advances in technology have changed this dynamic, with

far superior results). Miller later learned that her grandmother and two aunts had suffered breast cancer.

Miller and I work with newly diagnosed patients and breast cancer survivors regularly, so we understand

how life-changing the diagnosis is for patients and their family members. My wife is also a breast cancer

survivor who became one of my patients for breast reconstruction, so it's a personally important matter for

me as well.

In Miller's case, she wanted to be proactive not only for herself, but for her husband and children. It's

empowering for a patient to know she can essentially all but prevent developing breast cancer. It all made

sense to her. She wanted to move on with her life and raise her children without constant worry and

uncertainty. It was considered drastic when she had the procedure about a decade ago. But now, with

celebrities like Angelina Jolie and Christina Applegate choosing this type of mastectomy and discussing the

topic, it's been a big help for others.

Remember that even if a woman is BRCA negative, as was Miller, it's possible other gene mutations remain

undiscovered. The risk of future breast cancer is difficult to quantify, as most research studies involve

patients with a history of BRCA1 and BRCA2 mutations. In many of those patients, a pre-emptive

mastectomy reduces risk by at least 90 percent. But outcomes depend on the amount of breast tissue left

behind, and other variables. Mastectomies do not totally eliminate breast cancer risk — but do drastically

reduce risk and save lives.

One of the key issues I see in my practice is uncertainty about breast reconstruction. A University of

Michigan study found that seven out of 10 women did not fully understand their reconstruction options.

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