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Preventive Double Mastectomy, What You Should Know

Preventive double mastectomy

Updated May 15, 2013--It's a decision no woman ever wants to make: having a preventive double mastectomy. Yet 37-year-old actress and activist Angelina Jolie made the decision to undergo the surgery, as do many other women each year, because they have a cancer gene that could cause their death. Here are some things you should know about this procedure.

What is a preventive double mastectomy?

The decision to undergo preventive double mastectomy, also known as bilateral prophylactic mastectomy, is sometimes made by women who have learned they have the so-called breast cancer genes--BRCA1 or BRCA2. The presence of these genetic mutations greatly increases a woman's chances of developing breast cancer.

Preventive double mastectomy is also occasionally undertaken by women who have a strong family history of breast cancer or who have a condition known as atypical lobular hyperplasia or lobular carcinoma in situ. In all of these situations, women take this drastic measure in hopes of avoiding the development of breast cancer in the future.

In the case of Jolie, whose mother Marcheline Bertrand, died at age 56 of breast cancer, having the double mastectomy has reduced her chances of developing breast cancer from 87 percent to less than 5 percent, according to her doctors. Another high-profile woman, 24-year-old Allyn Rose, who was a Miss America contestant, also recently underwent the procedure. Allyn was only 16 when her mother died of breast cancer and she, like her daughter, had a genetic predisposition for the disease.

Although surgically removing both breasts is a dramatic move, it can save lives. Research indicates that prophylactic mastectomy may reduce the risk of breast cancer by 100 percent for women who have a BRCA genetic mutation or a strong family history of the disease, according to WebMD.

Any woman who makes the decision to have a preventive double mastectomy embarks on a courageous journey, but it is often the well-known or famous people who make the news. Among the women in this latter category who made that decision are Sharon Osbourne and Christina Applegate, and now Angelina Jolie.

A preventive double mastectomy is still no guarantee that breast cancer will not develop, because clinicians cannot be certain they have removed all tissue that could become cancerous. However, it is a chance some high-risk women are willing to take.

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On the positive side, women who elect to undergo preventive double mastectomy have several surgical options. Surgeons can use skin-sparing techniques, which preserves the breast skin, even though it involves removing most of the glands where breast cancer could develop, as well as the nipple and surrounding tissue.

Nipple reconstruction is also possible, and there are several techniques surgeons can use to make this possible. While previous techniques have involved using skin taken from the labia, a more common approach today uses skin taken from the reconstructed breast.

Women may also opt to undergo breast reconstruction along with skin-sparing mastectomy, which not only eliminates the need for another procedure, but also gives a woman back her figure and a chance to recover from only one surgical procedure.

More about the BRCA genes
Both the BRCA1 and BRCA2 genes are known as tumor suppressors, and they have been linked to both hereditary breast and ovarian cancers. Women and men can inherit these harmful gene mutations, and both sexes can take a genetic test (blood test) to identify if they have the genes.

According to the National Cancer Institute, about 600 out of 1,000 women who have inherited a mutated BRCA1 or BRCA2 gene will develop breast cancer. This compares with 120 out of 1,000 in the general population, or in other words, women with the mutation have about a five times greater risk of getting breast cancer.

Women like Angelina Jolie and Allyn Rose face a decision that will change their lives. In fact, choosing to undergo a preventive double mastectomy can help ensure they and other women who have these mutated genes have a life.

Jolie A. My medical choice. New York Times. May 14, 2013
National Cancer Institute

Image: Morguefile