Do I Keep My Breasts?
After the Surgery continued...
Breast reconstruction is another option to consider. There are two main choices: breasts filled out with fat taken from elsewhere on the woman's body or those shaped with saline implants. Those fashioned from a woman's own fat have the advantage of feeling more like a real breast, Vahdat says. But for some women, implants are the only viable option. Small says she would have preferred to have breasts formed from her own fat, but she was too thin.
Still, Small says she's happy with the results. "I had the most wonderful reconstructive surgeon," she says. "It took a long time. They had to reconstruct the nipples and stretch the skin. But they look very good."
Making the Decision
With all of these factors to consider, Vogel suggests that women who learn they are positive for one of the BRCA mutations take some time -- perhaps three to six months -- before making a final decision. "We tell women not to do anything in a hurry," Vogel says. "We tell them to talk to people. And we remind them that once their ovaries and breasts are gone, they're gone forever -- we can't reverse this procedure."
Indeed, one of the major impacts of removing the ovaries is sterility, meaning women can no longer bear children. Perhaps for this reason, the Lancet study found that most of those who opted for gene testing and ovarian removal were young women who already had children.
Even with all of the drawbacks, for many women removal of their breasts and sometimes their ovaries is well worth it. It reduces their fear of getting breast cancer. A recent study from the Mayo Clinic, published in the July 19, 2000 issue of the Journal of the American Medical Association found that of 572 women who'd had double preventive mastectomies between 1960 and 1993, nearly 70% felt good about their decisions. And nearly 75% said they worried less about breast cancer.
Small, for one, says she's still happy with the choice she made three years ago. "When you get cancer, you have to go through a period where you don't feel good and don't know what is wrong with you. And then you have radiation and chemotherapy," she says. "It's better to have the surgery and to avoid having cancer."
Linda Carroll is the women's health columnist for MSNBC. Her health stories have also appeared in a variety of publications, including The New York Times, Newsday, The Los Angeles Times, The Chicago Sun Times, and The Detroit Free Press.