Susan MacLennan, MD, is a plastic surgeon at the University of Vermont Medical Center

Susan MacLennan, MD, is a plastic surgeon at the University of Vermont Medical Center

Angelina Jolie was in the news last week. This time, it was for a very different reason than movies, beauty, or even humanitarianism. As many of those reading may already know, Jolie wrote an op-ed for The New York Times explaining her decision to have both of her breasts removed and reconstructed in order to decrease her risk of breast cancer (Read “My Medical Choice”). Through genetic testing, she learned that she carried a mutation in the BRCA1 gene. Her doctors estimated that she had an 87% risk of developing breast cancer. After watching her mother die of ovarian cancer (also associated with BRCA1 mutations), she decided to have preventive double mastectomy with reconstruction.

Every week in my plastic surgery practice, I meet women faced with the same choice as Angelina. They may have watched their mothers, grandmothers, and sisters battle breast and ovarian cancers, and they want to take control of their options and make a pre-emptive strike. Some call themselves “pre-vivors.” For those who make the decision to have prophylactic (preventive) mastectomies, the UVM Medical Center offers a variety of reconstructive options that can help restore a sense of wholeness and femininity, while also decreasing the risk of developing breast cancer to approximately 3 percent.

Many women also choose to have their ovaries and fallopian tubes removed, but since BRCA1-related breast cancers often happen at a younger age than do ovarian cancers, most have the breast surgery first, often as soon as they’re finished having children.

Breast surgery today is very different than my grandmother’s mastectomy. We still remove the breast tissue, but in many cases we’re able to keep the skin of the breast and sometimes even the nipple. The space where the breast tissue was is filled with either a breast implant (as in the case of Jolie), or with a woman’s own tissue from elsewhere on her body where she has a little to spare (tummy tuck anyone?). In some cases, we’re able to do the entire reconstruction in one stage with “nipple-sparing, direct to implant” reconstruction. In others, such as Jolie’s, it takes several stages to get to the finished product. The reconstructive approach is tailored to the specific needs of each woman. These are real operations and real recoveries, but advances in surgical technique, implants, and technology have helped improve outcomes in recent years.

The decision to have a mastectomy is a tough one for any woman to make, certainly so for a woman who is pursued by paparazzi and has photos of her face and body in all manner of media outlets every week. It does remind us, though, that those who seem to have everything: beauty, fame, brains, success…still live in the same bodies as the rest of us and are faced with the same hard medical choices. I applaud Jolie’s decision – especially her willingness to step forward and educate other women about the options available to them.

Fletcher-Allen’s Board-certified plastic surgeons work closely with our breast surgery colleagues and offer a variety of reconstructive options for breast cancer treatment as well as for reconstruction after prophylactic mastectomy, right here in our community.

For more information or for more information on how we can help you learn about your options, please visit UVM Medical Center Plastic Surgery.

Watch the WCAX-TV (Local CBS affiliate) interview with Dr. MacLennan.

Susan MacLennan, MD, is a plastic surgeon at the University of Vermont Medical Center. Learn more about the UVM Medical Center Plastic Surgery

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