This may not be the right forum but I really don’t know where else to go. My ex-fiancé has been participating in a cancer study for nearly 5 years now. She has a particularly poor family history when it comes to breast and ovarian cancer. Based on the results of the study as well as other tests performed by her oncologist, they have recommended that she undergo a preventative mastectomy on both breasts.
I’m fully supportive of her decision but I guess I really don’t know anything about this sort of surgery. It appears to make sense to me but just how radical is it? How is the reconstruction? She’s obviously very nervous about the procedure. Have any dopers had this procedure done or do they know anyone who has had it done? Any thoughts or comments would be appreciated.
Mods: Please move this to another forum as appropriate.
It’s radical, all right. My mother had a full or radical mastectomy about 15 years ago. She opted not to have any reconstructive work, as the prospect of bad silicone implants did not appeal to her. She’s got an external prosthesis - before the mastectomy, they took a cast of the breast and made a replica that fits into a special bra.
Just a few weeks ago, she had a lumpectomy on the remaining breast. She’s actually been having some regrets about not just having another radical as the recuperation from the lumpectomy is (for her, at least) more painful than from the mastectomy.
FWIW, Mom’s in the northwest suburbs, and she’s been just raving about how wonderful everyone is at Lutheran General’s Breast Center up in Park Ridge.
Thanks. I hope your Mom is ok. I think she’s having it done at Northwestern. I’m gutted about the whole thing and I really want to be there for her. The more I know the better friend I can be.
It’s definitly radical, but not unheard of. A very close friend had it done just after christmas last year. She has had two reconstructive surgeries, no silicone. She had lipid grafts from her hind quarters, and a special tattooist who shapes or draws a new nipple. She is a friend of the family and has a very good support group she attends weekly. The person in the OP may want to look into this.
I’m curious about this too. Not for personal reasons (I’m a guy), but my sister has mentioned it a few times. She’s got a family history that would strike fear into the heart of any woman. Our mother and maternal grandmother both died in their early fifties of breast cancer, and there are no small number of deaths and non-fatal cancers among the women on that side of the family from breast and other woman-only forms of cancer.
Is this a real prophylactic? Is it often recommended? Or is it considered kind of on the fringe? Or was it once sensible, but now not so much because of improved detection, prevention and treatment?
A lady preacher in town here had this done a couple of years ago. She went in for exploratory surgery on one breast, and they found a malignancy. She gave the go-ahead to remove both breasts as a preventative measure.
She opted for reconstruction, and she told me that she is happier today with her ‘false’ breasts. She was able to get rid of the anxiety of breast cancer, while also ‘downsizing’ to a manageable B cup when before she was a DD. It was a win-win for her.
Every lady is different, but I would glady go through a double mastectomy if the situation called for it. YMMV.
Medical authorities only recommend this for women who have an extremely high risk of breast cancer. This is NOT recommended for the average woman. Removal of ovaries and uterus is recommended in women who, in addition to a high breast cancer risk, also have a very high risk of ovarian cancer. These days, it’s usually in connection with one of the identified mutations that result in a better than 50/50 chance of getting breast cancer in a lifetime, or women who’s family history indicate there may be an unidentified gene or genes at work.
Also removing various bits to prevent cancer is extreme, there is precedent in cases like retinablastoma - which results in removing the eyes of young children and has the side effect of complete blindness - people at very high risk of colon cancer having their colons removed and so on. These are also pretty extreme instances of “hacking away” at people. It’s only OK in very specific circumstances.
These procedures do not guarantee that you will never have cancer, but it does substantially lower the risk. The advantage, aside from risk and anxiety reduction, is that a reconstruction can be done in a more controlled manner, in a person who isn’t sick and likely will heal better than someone simultaneously battling cancer.
You can google “prophylactic mastectomy” for a number of sites that address some of your questions.
In brief, in a truly prophylactic bilateral mastectomy (ie not the removal of one breast for cancer and the other one for prophylaxis) the nipple, areola, and breast tissue are removed, down to the pectoral muscle. In patients who will undergo immediate reconstruction (more later), this can be done via circular or slightly elliptical incision that runs around the areola, and most of the breast skin is saved to cover an implant or tissue flap. This carries the tradeoff that some glandular breast tissue may be left on the back of the skin flap, and/or that the flap may be too thin to preserve good blood flow, resulting in poor healing.
If reconstruction is not an issue, then a larger elliptical incision is used, leaving less skin behind such that the skin edges will come back together lying directly on the pectoral muscle without tension or redundancy.
Immediate reconstruction can include the placement of a tissue expander bag (a sort of saline implant that can be gradually inflated over many weeks prior to replacement with a final implant), or a tissue flap - a section of muscle, fat, and skin moved from some other place on the body, with care to preserve its blood supply.
The lymph nodes in the armpit are not normally taken in a prophylactic mastectomy, but the ‘tail’ of the breast may extend right up to them.
With or without immediate reconstruction, ‘drains’ are normally placed between the chest wall and skin flaps through a separate small skin incision. The drain is basically a flexible hollow tube with multiple side holes at its far end that is connected to a suction device outside the body. This serves to draw the skin flap snug against the underlying tissue and to prevent the accumulation of blood and serum in the wound cavity. The drains are left in until the daily output drops below a threshold value, and then they are pulled out. This can take anywhere from a few days to a few weeks.
eta: I should not have let my reaction to an earlier post keep me from answering Lochdale’s original questions. My apologies.
Forgive me for being bitter. Had I listened to doctors, not only would I have probably not been able to carry my daughter to term, but I wouldn’t have been able to have her at all. Most of the women in my family (And all in my direct line) have had radical hysterectomies. I was told when I was 18 I’d get cancer if I didn’t do what the doctor said. I couldn’t afford what the doctor said and I’m 39, still get regular checkups and am still, JUST FINE and most importantly, not scarred from their desire to hack away at my cervix over the years.
Bear in mind, I can not fathom a woman choosing to die rather than lose her boobs. It just seems that our naughty bits seem to be more disposable than mens. It’s a sensitive subject for me because of my history.
I would never, ever recommend someone not doing what is right for their health, however, I would absolutely make sure what was recommended WAS right for my health. Second, Third opinions and all that.
It just occurred to me. I took my dog to the vet once about a toe that was messed up, the doctor told me it was cancerous, it needed to be amputated and that cancer would spread quickly through out her body and I needed to “say goodbye” to her. Three days later the labs come back, it was a basic infection. No cancer, no spreading.
It appears your history has seriously skewed your perspective.
Whether or not radical mastectomy is an effective preventative for breast cancer has absolutely nothing to do with men. Implying that it is part of some vast anti-woman conspiracy shoots right past Hysteria into Whackadoo Land.
Forgive me for being bitter. Had I listened to doctors, not only would I have probably not been able to carry my daughter to term, but I wouldn’t have been able to have her at all. Most of the women in my family (And all in my direct line) have had radical hysterectomies. I was told when I was 18 I’d get cancer if I didn’t do what the doctor said. I couldn’t afford what the doctor said and I’m 39, still get regular checkups and am still, JUST FINE and most importantly, not scarred from their desire to hack away at my cervix over the years.
Bear in mind, I can not fathom a woman choosing to die rather than lose her boobs. It just seems that our naughty bits seem to be more disposable than mens. It’s a sensitive subject for me because of my history.
I would never, ever recommend someone not doing what is right for their health, however, I would absolutely make sure what was recommended WAS right for my health. Second, Third opinions and all that.
It just occurred to me. I took my dog to the vet once about a toe that was messed up, the doctor told me it was cancerous, it needed to be amputated and that cancer would spread quickly through out her body and I needed to “say goodbye” to her. Three days later the labs come back, it was a basic infection. No cancer, no spreading.
But not unique to Auntbeast. I remember blagging a read of a lady friend’s copy of Spare Rib back in the Eighties, and it had someone going off on basically the same rant.
To further expand the hijack…and not directed at you Auntbeast (“A Wrinkle in Time”?)
Whenever I hear “The Doctor told me to… (insert bad option here: terminate, put him in an institution, give up and die)!”, I sometimes think “Well, I know that’s what you heard, but I’m not sure that really what was said.”
I’ve worked closely with all sorts of Doctors for 15 or so years and have never once heard a Doctor make a blanket statement like that. Fairly recently, I sat in on a conversation about particularly difficult situation between a Doc and a patient/family. Later, the family invited me to view their website and I was very surprised to read their view of that conversation.
Anyway, best wishes to your friend, Lochdale. I don’t know very much about the ins- and- outs of breast reconstruction but do get to seem some reconstructions. Ususally, the reconstructions I see are several years post-op when the women are getting more mundane/routine OB-GYN services. The can say the quality of the reconstruction work has greatly improved over the years. The reconstructions I see now have smaller, finer scarring and much improved overall shape and appearance.
I am at high risk for breast cancer. My mother had breast cancer before she was 50 (had a lumpectomy, radiation, and chemo). My younger sister had bilateral breast cancer last year, at age 39 and had a double mastectomy. It appears that my mother’s breast cancer is back. I went to see a breast cancer specialist, and even with this very high risk, she didn’t recommend a prophylactic mastectomy. What she recommended was (1) genetic testing for BRCA1 and BRCA2 (negative); and (2) increased testing for breast and cervical cancer (including MRIs of the breast in addition to mammograms and vaginal ultrasounds yearly around the time of my usual pap smear).
Personally, I would only have a double mastectomy if a lump was found in one breast. Considering my history, I would consider it prudent. But there’s no way in hell I would have my breasts or ovaries removed (to reduce estrogen production) just on the off-chance I might get breast cancer, even with my family history. And that’s not because I am particularly fond of my breasts (I’m 43; I’ve breastfed two babies; I would enjoy perkier breasts from reconstruction) but because I think it’s mutilation for no good purpose; why would monthly self-examinations and regular mammograms/MRIs not be sufficient? I know that won’t prevent breast cancer, but early detection increases the chances of survival.
But had you tested positive for BRCA1 or BRCA2 she might have offered prophylactic mastectomy as an option. That’s the context in which I’ve heard of people having it done.
She actually recommended the extra observation in the event that I was positive. She also said it was prudent even if I were negative. But that was her recommendation for positive results on the genetic testing–MRIs and vaginal ultrasounds. Not prophylactic mastectomy or removal of my ovaries.