Breast Reconstruction: A Woman’s Choice


Angelina Jolie’s brave announcement in the op-ed section of The New York Times in mid-May brought the topic of breast cancer and reconstruction to the forefront. Her story was personal. She shared medical details that educated many people on why her choice was important. Some may not have known that there’s a BRCA gene test that could help a woman determine if she has a genetic disposition for breast and ovarian cancer.

The BRCA1 and BRCA2 genes are directly linked to developing hereditary breast and ovarian cancer. Harmful mutations of these genes can increase a woman’s chances of cancer, but not every woman who has these mutations is guaranteed to get the disease. Like Jolie mentioned, because her mother passed away at age 56 from aggressive breast cancer and she possessed the gene mutation, her chances were increased to 87 percent for breast and 50 percent for ovarian cancer. Not shared in the article, but adding to the concern, Jolie’s maternal grandmother passed away from ovarian cancer at the age of 45.

It’s your decision

Early detection and treatment for breast cancer, which could include a mastectomy that removes all breast tissue or a lumpectomy with radiation therapy, has saved millions of lives. A lumpectomy is appropriate for early detection and tries to maintain the shape and integrity of the breast. The chance of recurrence is slightly higher with lumpectomy and in the case of preventative surgery, a mastectomy is more appropriate and usually does not require radiation therapy.

Psychological considerations

While having breast cancer in your family and testing positive for the gene mutation does not mean you are guaranteed to get cancer, most women who have gone through the process with a family member understands the choice Jolie made. The trauma of losing a family member to cancer is a strong motivating factor to get tested, watch your own health and take the necessary precautions. Making the choice to have preventative surgery is a difficult one because the breasts are so highly visible, a large part of a woman’s identity and sense of femininity.

Support Systems

Because plastic surgeons come in at the end of the cancer surgery, we see a lot of the emotional fallout after mastectomy and lumpectomy. Following treatment, many women experience depression, pain, and side effects from drugs and radiation. Along with having a positive outlook and working with doctors that you trust, it’s important to have a strong support group. Like Jolie mentioned, she has a supportive family, husband, and great friends to help her through this difficult time. Many survivors join groups and talk to other women who have undergone the same experience. Knowing what to expect, sharing with those who understand, and having supportive, positive people around will go a long way for recovery.

Breast Reconstruction

Once there’s a diagnosis of breast cancer and a surgical plan for removal, what comes next for a woman? In 1998, The Women’s Health and Cancer Rights Law mandated that health insurance companies cover breast reconstruction following mastectomy. This was an extremely important law to help women recover from breast cancer. Not covering breast reconstruction is like not offering prosthesis to someone who has lost a limb. Now women along with their doctors can decide on their options after cancer surgery. The most common choice is an implant after expanders, which is a tissue flap procedure where tissues from other areas of your body are transferred to your breast.

Those who choose to have their own tissue replace their breasts will have two surgery sites – the breast(s) and a donor site, which is most commonly the abdomen or the upper back. This procedure has less chance of achieving symmetry of the breast on both sides, even with a double mastectomy because the tissue behaves like the rest of your body and is susceptible to weight changes and fluctuations. An added benefit of a TRAM flap surgery that takes tissue from the abdomen is a tummy tuck that could flatten or slim down the waist. On the flip side, if you’ve already had a tummy tuck, this option might not be viable for you due to lack of tissue.

The complexity of breast cancer, both the treatment and the emotional result, can’t be underestimated. There are new advances in both the surgery and treatment of cancer and the reconstructive techniques used every day. And until the day we have cured cancer outright, there are truths to be faced and hard decisions to be made. In plastic surgery, our goal is to make the choices bearable and to help restore those who have lost a part of themselves.

In the end, we hope every woman facing this similar situation has the same feeling Jolie expressed after her surgery. She writes, “On a personal note, I do not feel any less of a woman. I feel empowered that I made a strong choice that in no way diminishes my femininity.” Preventative or not, we hope to make all our patients comfortable with their bodies after this type of trauma or life change.