This month I have several breast reconstructions scheduled. Interestingly, all of the cases are bilateral reconstructions, and in 3 cases, the cancer is only in one breast and the mastectomy is being done prophylactically, and in 1 case, the patient has tested positive for a BRCA gene mutation and is electing to have prophylactic bilateral mastectomy.
I recently read a book by Jessica Queller called Pretty Is What Changes: Impossible Choices, The Breast Cancer Gene, and How I Defied My Destiny.
She is a television writer in her mid 30s who is tested for the BRCA gene mutation after her mother dies of ovarian cancer, after surviving breast cancer. It is a frank account of her emotions upon learning the results and how she dealt with the choices she had, ultimately choosing bilateral mastectomy and reconstruction with tissue expanders and implants. She did seem to suggest that a female plastic surgeon was somehow more "qualified" to understand her ordeal, though I would suggest this as a generalization. In any case, I thought it was a timely book, considering that the BRCA gene mutation testing is inevitably going to become more common, and prophylactic mastectomy seems to be a choice that many more patients will be considering.
She is a television writer in her mid 30s who is tested for the BRCA gene mutation after her mother dies of ovarian cancer, after surviving breast cancer. It is a frank account of her emotions upon learning the results and how she dealt with the choices she had, ultimately choosing bilateral mastectomy and reconstruction with tissue expanders and implants. She did seem to suggest that a female plastic surgeon was somehow more "qualified" to understand her ordeal, though I would suggest this as a generalization. In any case, I thought it was a timely book, considering that the BRCA gene mutation testing is inevitably going to become more common, and prophylactic mastectomy seems to be a choice that many more patients will be considering. I am aware that women often choose to have a mastectomy of the normal breast at the time of mastectomy to treat the breast with cancer (prophylactic on the normal side, therapeutic on the side with cancer). What I hear from women who make this choice is that the uncertainty of knowing what the future holds if the normal breast is not removed, the need for constant mammographic screening, the question of why they got breast cancer in the first place, which by itself serves as a risk factor for the development of breast cancer in the future, leads many women to consider bilateral mastectomy. With reconstruction outcomes improving, I think that women see a bilateral mastectomy with reconstruction as an empowering choice.
As always, I look forward to hearing from readers especially for suggestions regarding future blog posts.
