Christina Applegate's Mastectomy: FAQ
Breast Cancer Survivor Christina Applegate Opts for Preventive Double Mastectomy and Breast Reconstructive Surgery
Did Applegate make a good choice? continued...
"Because her risk of an additional breast cancer is extremely high, in the range of one in two, why take a chance?" asks Eli Avisar, MD, breast cancer surgeon at the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine.
Gisella Alvarez, RNC, is a nurse at Mercy Medical Center. Two years ago, at age 44, Alvarez learned she had stage I breast cancer in one breast. She decided to have both breasts removed and get breast reconstruction. Her case wasn't exactly like Applegate's -- Alvarez had an elderly aunt who had had breast cancer but she hadn't had the BRCA gene test -- but she took a similar approach.
Alvarez says Applegate's decision was "brave" and "smart because life is too short. It's not worth living your life worrying every six months when you have to go back for tests and more tests -- and hoping that it's not going to come back. With this way, you really increase your chances of not having to worry about it again and live your life."
Does double mastectomy totally eliminate her risk?
Almost, but not quite; there's an estimated 5% chance of breast cancer after such a procedure, notes Neil Friedman, MD, FACS, medical director of the Hoffberger Breast Center at Mercy Medical Center in Baltimore.
He explains that there's no clear line where breast tissue ends.
"When you're in the operating room, it's not like you can look and say, 'All that yellow tissue is breast tissue and all that white tissue is fat.' So you try and take all the tissue out that you can, but you can leave isolated breast cells underneath the skin. Everybody does; there's not a surgeon in the world that can do that and remove all of the cells. That's why there is a small risk of having a breast cancer develop in one of those cells -- pretty uncommon, but it can happen," says Friedman.
Friedman says that immediate reconstruction -- starting the process at the time of the mastectomy -- "is something that should be offered to all patients."
"I offer it to all of my patients and if I think there's a reason why they shouldn't get it from a medical perspective, then I [explain why] I think it's advisable to delay the reconstruction. But they should at least have that conversation with their surgeons," says Friedman, adding that breast reconstruction is not an insurance issue, because it "must be paid for by federal law," regardless of the patient's age.