Angela Jolie, BRCA genes and saving nipples
Like everyone, I was surprised to hear the recent news of movie star Angelina Jolie’s recent surgery, but very pleased to hear she took a proactive approach to her health and chose to undergo “risk reduction” surgery and breast reconstruction.
The BRCA gene does not always have to be a death sentence or result in cancer inevitability. Many women I see who have the BRCA gene also choose to undergo prophylactic mastectomies and breast reconstruction to decrease their overall lifetime risk of developing breast cancer (often greater than 80% during a woman’s lifetime).
In my private Plastic Surgery practice that is focused 50% on advanced breast cancer reconstruction, I choose to work with Breast Surgeons who specialize in nipple-sparing mastectomy (NSM). Saving the nipple in addition to all the skin of the breast (the “breast envelope”) preserves the natural breast shape and facilitates the smoothest and comfortable recovery, with the most NATURAL breast reconstruction results.
As opposed to the traditional two-stage (or more) tissue expander-implant reconstruction, we offer a state-of-the-art, single-stage immediate implant reconstruction that does not require placement of the implants below the pectoralis major muscles. Submuscular implants permanently change the pull of the muscle (its “vector”), it can interfere with muscle function and creates a distortion called the “motion deformity” whenever the pec muscle is engaged. Some women complain of chronic muscle strain and stop performing upper body exercises because of pulling and pressure sensations when they use their pec muscles.
Single-stage implant reconstruction, on the other hand, places a permanent, postoperatively adjustable implant on top of the pectoralis major muscle at the time of nipple-sparing mastectomy, preserving muscle anatomy and function, and avoiding the motion deformity and related possible muscle strain.
The other option for breast reconstruction when implants are not used involves using the body’s own tissue, known as a “flap”. In my practice, I use Reconstructive Microsurgery to literally transplant skin and fat from the tummy or the inner thighs of a woman to reconstruct a breast WITHOUT sacrificing of major muscles of the body such as the rectus abdominis muscle (as in the TRAM flap of the 1980’s). These procedures are called the DIEP flap, SIEA flap and TUG (inner thigh) flap. Click on the links to learn more about microsurgical breast reconstruction options.
Some women who find they are BRCA gene positive also decide to have a prophylactic (preventative) “oophorectomy” (removal of the ovaries and fallopian tubes). This can be arranged at the time of their mastectomy and breast reconstruction, or done as an outpatient procedure through a laparoscope (minimally invasive) before or after their breast reconstruction.
Congratulations again to Angelina and to all BRCA-positive women who choose to take a proactive approach to their health, and their lives!
The following are additional links and resources for women who are BRCA gene-positive and are seeking additional information about preventative mastectomy and breast reconstruction:
- Nipple-sparing mastectomy (NSM)
- Overview of breast reconstruction options
- Immediate single-stage breast reconstruction
- DIEP and SIEA flap breast reconstruction
- TUG (inner thigh) flap reconstruction
- Breast reconstruction following lumpectomy and radiation
- Advanced Breast Reconstruction pamphlet (downloadable PDF)