Most women that we see for breast reconstruction at our Lond Island practice come to us after a breast cancer diagnosis. Jean's story unfolds a little differently; she was never actually diagnosed with breast cancer. She underwent what is known as a prophylactic bilateral mastectomy – breast removal surgery to prevent cancer in women who are at particularly high risk.
Listening to Her Intuition
Jean always suspected that breast cancer was in her genes. When Jean was just 12 years old, her mother died of breast cancer; she was only 47. Jean's maternal grandmother, too, died of breast cancer. Jean states "I always knew this would be something I'd have to deal with."
Her proactive approach to her health involved scheduling her annual medical exams in a way that maximized her chances of early detection. "I'd schedule my yearly physical, my mammogram, and my annual OB/GYN exam so that they were spaced 4 months apart. This was my way of improving the odds of catching anything abnormal early on," recalls Jean.
In January of 2010, her mammogram results came back showing "microscopic changes." Jean's doctor suggested that, as a precaution, she increase the frequency of her mammograms to every 6 months. Jean had other ideas. "That's not my way of doing things," states Jean. "I immediately made an appointment with the breast specialist."
Although the breast specialist didn't see any cause for concern in Jean's mammogram results, she suggested that she consider genetic testing. She told Jean that, considering her family history, it might be a good idea, and that in all likelihood the results would be reassuring. Only about 1% of the population has a BRCA gene mutation associated with elevated cancer risk.
Jean scheduled the genetic testing, and as she had always suspected, she tested positive for the BRCA2 gene mutation. This put her at much greater risk for developing breast, ovarian, uterine and colon cancers.
Taking Decisive Action
Without hesitation, Jean scheduled a preventive bilateral mastectomy with her breast surgeon. To some, that may seem like a bold and courageous choice, but Jean views it as problem-solving. "You have a health problem, you take care of it," she says frankly. The breast specialist recommended Dr. Romanelli for Jean's reconstruction.
Upon meeting with Dr. Romanelli, Jean was immediately put at ease and felt comfortable that he was the right choice for her breast reconstruction. "Everyone in the office was very nice. There was no question too small for Dr. Romanelli or his staff. He explained everything in such detail – he even drew pictures."
Without telling even her closest friends, Jean underwent a bilateral mastectomy and immediate breast reconstruction. The surgeon was able to spare her nipples and areolas, and Dr. Romanelli performed direct-to-implant reconstruction on Long Island. He placed breast implants under the muscle, using AlloDerm® to create a supportive "sling." Since Jean is very thin, she did not have enough fat for flap reconstruction; however she appreciates that she did not have to undergo tissue expansion, which involves a second surgery at a later date. She was also happy with the minimal degree of scarring left after her procedure, which she describes as "just a 'C' shaped scar under my nipple."
Jean awoke from surgery with one drain in each breast. She also had incisions under her arms where the sentinel lymph nodes had been removed for cancer testing. During the surgery, the lymph nodes are tested using radioactive dye, and the tissue behind the nipple is also tested for cancer. On her first post-op trip to the bathroom, Jean was shocked by what she calls "Easter-egg pee," – urine that was brightly colored from the injected dye. "That was something I wish I had been warned about," she laughingly states.
Despite that little surprise, she recalls that Dr. Romanelli was extremely meticulous, both preoperatively and postoperatively. "His instructions for washing/disinfecting were probably twice as thorough as the norm," she says. "He was so careful to take every precaution, both before and after my surgery. I saw him for follow up immediately, then twice a week for several weeks, then gradually less as I healed."
Getting Back to Normal
Although Jean did not dramatically change the size of her breasts – she went from a "B" to a "C"– it took some time to adjust to her reconstructed breasts. "They're a little different because they're not 'your boobs.' They're bigger, higher, and swollen at first." However, Jean was back to horseback riding within 2 months, and feeling very comfortable with her implants at about 7 or 8 months.
As Jean reflects on her journey, one thing stands out in her mind. "My friends – when I finally told them about it – kept telling me how brave my decision was. I never thought of it that way. I had a medical problem and this is what I had to do to alleviate it," she states matter-of-factly. She also went on to have her ovaries removed 4 months after her mastectomy as a precaution against ovarian cancer. "It's really not all that bad. If it happens, it's not the end of the world. You just do it, and you get on with it."