BRCA/Preventative Mastectomy

BRCA/Preventative Mastectomy

Women who decide to have prophylactic mastectomy often choose to have breast reconstruction surgery, either at the same time as prophylactic mastectomy or at a later time.

In this Prophylactic Mastectomy and Breast Reconstruction video series, watch as surgeons at the Center for Restorative Breast Surgery explain how prophylactic mastectomy can reduce the risk of breast cancer by about 90%. To restore a sense of wholeness, many women decide to have breast reconstruction immediately after prophylactic mastectomy surgery.


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Dr. Ordoyne: When my patients come to me, some of their biggest concerns are, “When am I going to develop cancer, or has it developed in me already?” 

Kerry: Between 31 and 32, my anxiety just really started to increase as I was going to the doctor because I knew I was getting closer to the time that my mom had been diagnosed. So, I remember at one point I was waiting for the results of a mammogram, and I mean my I’m sitting there waiting, and the anxiety was just like, and the, the nurse came back in, and everything was fine, but she said, “You know, have you ever thought about getting genetic testing? You know, I can just see your anxiety with this.” 

Dr. Stolier: I can truthfully say that when we began to do genetic testing, it changed everything, We have empowered women to make decisions about their own health, and we’ve empowered them with information.

Lorell: It’s an awful thing to have to face, but here I am, given information. You’ve got a pretty good cancer risk. Well, let me do something about it.

Dr. Stolier: Well, it all comes down to risk. There’s a risk of developing breast cancer, and there’s actually a risk of dying from breast cancer. And I think that any woman who has tested positive for one of the gene mutations is concerned about these; both of them. 

Dr. Ordoyne: The biggest reason for talking to your physician about having a prophylactic mastectomy is it’s better to treat your disease prior to getting it rather than to wait till you have cancer and then treating it at that time. 

Dr. Stolier: Prevention is everything; it’s everything. So, if we look at all the options that we have in front of us, risk reduction surgery reduces a woman’s risk of developing breast cancer and subsequently dying potentially from that breast cancer by 90%, and that’s probably as good as we have at the moment.

Dr. DellaCroce: To deliver the highest quality at the end of the day, it requires, it demands a team of experts who collaborate and work together because the outcome, both in terms of the risk reduction and the ultimate result in terms of the restoration of wholeness, comes with that first incision. 

Dr. Ordoyne: By working with the plastic surgeons, we can have a more customized approach in developing techniques of restoring the breasts to its natural state. And that way, I can do my mastectomies through incisions that will be more pleasing cosmetically. 

Dr. Stolier: What we try to do is to try to help women feel better about themselves, feel better about their body image, and overall have a better quality of life.

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Dr. DellaCroce: When they’re making a decision for preventive or prophylactic mastectomy, that’s a high-stakes event. They’re afraid if they make a decision to reduce that risk, that there will be a lasting deformity or disfigurement; that they’ll lose their femininity in whole or in part. 

Lorell: The idea of losing my breasts was daunting; it really was. I believe that I have the right to be whole the way that I was before. This is how I was before; I have the right to be like that afterward. 

Kerry: It’s okay to still feel like this is part of you that you’re losing, and you have to be, you know, that it’s okay to grieve that.

Mandy: As a 27-year-old single, it was it wasn’t something that I thought I would be going through at 27, but it was definitely something I needed. 

Dr. Sullivan: This is a tough decision to go forward and have a prophylactic mastectomy, with a concern that they’re gonna be disfigured, there won’t be a woman, they’ll lose their self-worth and self-esteem. I think they need hope; they need guidance; they need assurance; they need a feeling of self-worth. That’s where the reconstruction really comes in. 

Dr. DellaCroce: In terms of options, when you’re considering prophylactic mastectomy with breast reconstruction, you can choose to use an implant or your own tissue. For implant reconstruction, after the breast tissue is removed, a breast implant is inserted through the mastectomy incision and placed beneath the pectoralis major muscle. The implant is supported below by a collagen sheathing, known as dermal matrix material. The incision is then closed. In a DIEP flap reconstruction, an incision is made from just below your belly button down to your panty line. A portion of skin, fat, and blood vessels is taken and inserted through the open mastectomy incision. The blood vessels in the flap tissue are attached to the blood vessels on the chest wall. The flap is then formed into a breast shape, and the incision is sewn shut. In an S gap reconstruction, a section of skin, fat, and blood vessels is taken from the top of your buttocks and moved up to your chest. Then the blood vessels are attached, the flap is then formed into a breast shape, and the incision is closed. There are also additional options for breast reconstruction available to women today.

Kerry: Just being able to, if you’re put in this position to know that there are options out there, to go through this and to not feel like you’re losing a part of yourself; you’re whole. 

Dr. DellaCroce: Yeah, that’s where it comes full circle for us. To know that we’re able to deliver a service to you, to allow you to live a long, happy life and to look fabulous along with it. And then to have you look back and if there’s nothing you would change, that means we did a good job. 

Mandy: At such a young age, it was like, what am I getting into? How is this all gonna end up? But it’s ended up beautiful. 
Lorell: So, I would guess it was about six months, where I was healing, and I wasn’t so inflamed or swollen, and I looked and said, “I think I can really do this.” This is not going to be bad at all. You look really good with clothes on; this is really kind of cool. Let me look at me; I’ve got a flat tummy; I have beautiful breasts; this is going to be okay. It’s gonna be alright.

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Kerry: Growing up, I was overweight as a kid. And just really wanted to change myself, but I also knew that I needed to make healthy choices because of my family history, quite honestly. I was 10 years old, and my mom was diagnosed with breast cancer. I wish I would say that I didn’t remember the very beginning of it, but I do. We’re at my grandma’s house, and she got a phone call, and she sat right down. And I remember it was dark outside. Just knowing something was really not good. I was 10; I had a brother who was seven and then a sister who was three. So, I know that was what she was living for. And she did. She got through it, and she’s a super strong woman.

I chose to go through genetic testing in early 2012. I went into the test feeling very brave, very brave. And then you go home, and your mind starts to just start thinking about what’s gonna happen if it’s positive, what’s gonna happen if it’s negative. And your staring fear in its face and try to hide from it, but it’s not gonna go away. You’ve got to deal with it.

The first, honestly, the first thing was relief because I knew; I’m not wondering. Then it went into just numbness and anger. My world is crashing. I was mad at God. I was mad at everybody. I isolated myself. I knew what was up ahead. I’m gonna have to have a double mastectomy, and this is gonna be life-changing.

The thought of losing your breasts and like this is who you are as a woman. That’s a huge thing to get your head around. It’s losing a part of yourself, that you, that you’ve known, but yet, also telling yourself this doesn’t mean that, that changes who you are. It’s okay to still feel like this is part of you that you’re losing, and you have to be, you know, that it’s okay to grieve that. As they started to talk with me about the implants, I became more uncomfortable about what they were sharing with me. Knowing myself, wanting to be as natural as possible, I was just not personally comfortable with that option that they had given,

When I found the surgeons that could provide me with options that I was looking for, there was a piece like, this is doable. I can do this. By the time that I had actually gotten to surgery, I remember the morning waking up, and there was a sense of peace. I was ready, and there was peace.

I remember just looking in the mirror before getting in the shower and realizing there’s a lot of stitches. You know, there’s drains and I don’t know there’s this sense though I will tell you of like, I’m gonna do this. I’ve got to get through it. Like, I’ve got to just charge ahead.

I got back to running. I did more running than I had done before and just even eating healthier and being more conscious of that. I don’t feel defined by my breasts or how they looked, and seeing my body now, it’s like this is you. Like it’s natural, it’s who you are, and that it can be better afterwards.

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Lorell: My husband and I have been married for 26 years. We have two sons, we live outside of New Orleans, and we love living here. We’ve owned this restaurant for 26 years. I worked the register and help with the customers and that kind of thing.

There’s a thing in the restaurant business; if you have time to lean, you have time to clean. Living down here in South Louisiana, we have higher cancer rate. It’s almost the thing you don’t want to think about, but it’s always there. When my sister came down with breast cancer in 1995, she’s 16 years older than I am; she’s the oldest, I’m the youngest. So, I guess you know she was lucky, and the fact that they caught it right away let’s do something about it right away. My father was diagnosed with breast cancer in 2000. He was 74, and then he started chemo; lost all his hair. Got really sick, didn’t feel good at all, and radiation. He didn’t make it through the treatment.

I felt like it was a monkey on my back. That was just always there. I knew it was there; I knew it was there. And I just knew it was a matter of time. I was getting older; I was past the age that my sister was when she had her cancer. Going to get mammograms, my yearly mammograms, you know, you have to sit there after they take your films, and you got to sit there and wait, and you got to sit there and wait. And you’re thinking, is this the appointment where they’re gonna find something? Is this the day that they’re gonna call me back and say, “Mrs. Horne Brooke, can you step this way, please.” Is this gonna be it? Let’s get this show on the road.

So, I had been having a head cold, and I wasn’t feeling very well. And I was laying down for those few brief moments before homework and dinner and everything in the afternoon. And the phone rang, and my caller ID said Dr. Stolier, Alan Stolier. He could tell by my voice that I wasn’t feeling well. I said no, I’m not feeling well. I have a head cold, and he said, “Well dear, your results came back, and you have the gene mutation. Let’s come in; why don’t you come in, and we’ll talk about it.” I felt I was too young; I had too much to do. I had too much life in me. I was too young to just let fate take its roll of the dice. 86% shot of getting cancer, it’s big, it’s looming, and I feel that it’s here, and it’s only a matter of time. It’s only a matter of time.

It’s an awful thing to have to face, but here I am, given information. You’ve got a pretty good cancer risk. Well, let me do something about it. I’m gonna do something about it. I felt that I could make something happen. I didn’t have to wait for fate to step in. I was empowered by it. Look what a horrible toll this horrible disease was doing to us. I could take the reins and say, this is what’s available to me, this technology, these talented surgeons, modern medicine. I’m gonna take every advantage that I can possibly take. I want it all. I want it all.

So, I would guess it was about six months. Where I was healing, and I wasn’t so inflamed or swollen, and I looked and said, I think I can really do this. This is not going to be bad at all. 

Do you remember? I asked you if I were your daughter, would this be what you want me to do? And you said yes. 

Dr. Stolier: I would have said probably, absolutely. 
Lorell: I have a family business that I hope stays in the family for quite a while. I’d love to see my sons take it over. I’d love to see my grandchildren, but I’m really looking forward to it. Every minute is a gift, and I think we need to share that gift with everyone else that we meet in any way we can.

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Kerry: Since having her son Gabriel, I think that that’s been a big bond between us to really enjoy spending time with him. I’m his godmother, and he’s a very, very special person. 

Mandy: Watching my mom interact with my son makes me feel blessed. I’m grateful she is here and with us and able to give all the love in the world to him.

Kerry: Seeing her go through that was extremely difficult. I don’t even think I knew, at the time, how serious it was. 

Mandy: I knew of my mom having cancer then, but I didn’t really see what she went through. So I was kind of blind to it. I didn’t really understand it until I got older. Kerry and I had talked about getting tattoos together and said what if we do this for Mom. 

Kerry: My mom is the one who chose to go through genetic testing. Her doctor encouraged her. His actual words were, I think, “You need to get your head out of the sand and really think about doing this.”

Mandy: I think once my sister got tested, and she found out that she was positive, it really hit me hard; like, okay, this is serious, like it’s nothing to be playing around with. If I have it, I have a little boy who’s depending on me. I have a job — I’m a single mom. And I remember I called my sister, and I felt strong at first, but then I remember I just broke down and…

Kerry: I resonated with that. I know that feeling. I know that all those feelings that go along with that.

Kerry: You know, when she first saw me, like, okay, I’ve got to kind of wrap my arms around seeing my sister with drains, scars, and, she was open that I think it was a bit eye-opening for her. 

Mandy: This sister, who I’ve always seen as strong and powerful, she was just very quiet. I definitely had the thought after seeing her like… why would I want to put myself through this? Like, there’s no way I could do it. I didn’t know how I was going to do it or where I was going to find the strength, but again, I just kept thinking of Gabriel and knowing that I needed to do it for him. Whether I don’t breastfeed anymore is, you know, that’s it’s okay.

Kerry: I just remember this burning feeling in my stomach when they were just talking about the limited options that she had, and I was sitting there, and I’m like, “How can I not say anything?” This is my sister. I have to look out for her. I want to protect her. I want to give her the best options.

Mandy: I remember I was out to eat with my mom after that; my sister calls, just like, “You know, what, we’re gonna try to get you into New Orleans and have your surgery there. What do you think of that?” Because nipple-sparing was a big deal to me, it was a breath of fresh air. It was amazing that someone could actually suit my needs.

Dr. DellaCroce: The fact that Kerry, you were the pioneer, and then Amanda benefited from that trail having been blazed.

Mandy: I feel like it sucked while we were going through it, but I feel like it was God’s plan for us to go through it together.

Kerry: The bond is just so much greater, I feel like, so much deeper than it’s ever been before. I mean, having the situation that we face, I look at it like, a blessing that we had the opportunity to get ahead of it.

Kerry: It felt good to be able to take care of my sister in whatever way that I could. 

Mandy: I remember the first thing when I was in my room, and my family could come in. I remember my sister telling me you look great. It was just nice hearing that.
Kerry: You do.


SEE RESULT GALLERIES

The following contains images of advanced surgical breast reconstruction results and includes nudity.

BRCA Gene

Before & After Bilateral Nipple Sparing Mastectomy and Implant Breast Reconstruction

BRCA Gene

Before & After Bilateral Nipple Sparing Mastectomy and Implant Breast Reconstruction

BRCA Gene

Before & After Bilateral Nipple Sparing Mastectomy and SGAP Flap Breast Reconstruction

BRCA Gene

Before & After Bilateral Nipple Sparing Mastectomy and Implant Breast Reconstruction

BRCA Gene

Before & After Bilateral Nipple Sparing Mastectomy and APEX Flap Breast Reconstruction

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It was God’s plan for us.

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