{"id":485,"date":"2013-05-19T20:46:08","date_gmt":"2013-05-19T20:46:08","guid":{"rendered":"https:\/\/surgerytoday.com\/education\/?p=485"},"modified":"2013-09-16T00:24:27","modified_gmt":"2013-09-16T00:24:27","slug":"brca-mastectomy-angelina-jolie-and-my-thoughts-as-a-general-surgeon-in-modesto-ca","status":"publish","type":"post","link":"https:\/\/surgerytoday.com\/education\/brca-mastectomy-angelina-jolie-and-my-thoughts-as-a-general-surgeon-in-modesto-ca\/","title":{"rendered":"BRCA, Mastectomy, Angelina Jolie, and My Thoughts as a General Surgeon in Modesto, CA"},"content":{"rendered":"

I felt compelled to write a little bit on this subject. \u00a0I have been a breast cancer<\/a> surgeon and have worked together with my wife, Dr. Tammy Wu on breast reconstruction after I had done the breast cancer operation. \u00a0In fact, part of my dream, which has somewhat died, was to create a breast cancer center. \u00a0The same kind that Angelina Jolie had gone to for her treatment. \u00a0It involves many breast cancer specialists under the same roof.<\/p>\n

I had been one of the first surgeons in Modesto to bring sentinel lymph node<\/em> technology to breast cancer surgeries. \u00a0I had helped certify my other surgical partners at a group which used to be called McHenry Medical Group. \u00a0We were a group of 6 surgeons at the time. \u00a0This was the group that brought me to Modesto, CA. \u00a0I also had been trained to perform skin sparing mastectomies. \u00a0Dr. Wu and I have performed several of these procedures together here in Modesto. \u00a0Dr. Wu would assist me in these procedures and then I would assist her in the reconstruction. However in 2006, we made a decision to move Surgical Artistry more toward a cosmetic surgery – only – focus.<\/p>\n

Angelina Jolie’s surgery used sentinel lymph node technology, nipple sparing mastectomy techniques, and then followed up by breast reconstruction with tissue expanders and then with what I believe are anatomically shaped implants – possibly the implants that we have just been blogging about – the new\u00a0gummy bear breast implants<\/a>\u00a0– approved in February of this year. \u00a0Dr. Wu<\/a> has been familiar with all aspects of Angelina Jolie’s breast reconstruction with expanders and implants.<\/p>\n

But what is new to me, as a general surgeon who backed off from breast cancer surgery in 2006 is: The nipple delay procedure – I think this is genius!. \u00a0This procedure is usually done when patients have had previous augmentation or when there is fear of cancer hiding underneath the nipple area, and also for improving nipple\/areolar survival after mastectomies. \u00a0The blood supply is improved. \u00a0Dr. Tammy Wu explained to me that this idea is also done in plastic surgery procedures such as TRAM flaps – where a extraneous blood supply is cut off first and then a waiting period is done to have the rest of the blood supply improve – before performing the full surgery. \u00a0And I have never performed a double mastectomy. \u00a0I have received three requests (that I can remember) for this in my breast cancer surgery career, but I have turned all three of them down, but recognizing that it is a patient’s choice. \u00a0I have hooked them up with other surgeons. \u00a0I felt somewhat uncomfortable removing the mastectomies. \u00a0Not all of these patients has had definitive BRCA testing and at the time, and I would say that BRCA testing was newer back in the early 2000’s. \u00a0Thus some of these requests were based on just “disliking breast cancer” and wanting to “reduce breast cancer risk.” \u00a0But I know that breast cancer risk is present even after I do a mastecomy (meaning breast removal). \u00a0Why? \u00a0Because inevitably, I will leave some breast tissue behind, and much of the breast tissue left behind is in the nipple\/areolar complex. \u00a0And even if I take the nipple\/areolar complex (which is the standard mastectomy), I would leave some tissue and cells behind – especially on the skin flap. \u00a0If I made it too thin, the skin flap above could die. \u00a0Thus, I felt uncomfortable, personally, removing normal breasts – <\/em>even though I knew I was married to someone who could reconstruct them very well. \u00a0So even if I removed them, the risk of cancer was still there. \u00a0Essentially I was thinking that I would reduce a woman’s general risk of breast cancer from 10% (this was the figure I used back then), down to about 5%. \u00a0It wasn’t worth it for me. \u00a0But with BRCA testing, it is a different story as you read below (the risk reduction is greater because you start at a higher number BRCA mutation positive risk – 87% per Angelina Jolie’s doctors). \u00a0So perhaps if I was practicing breast cancer surgeries today, I would be more “comfortable” with performing prophylactic double mastectomy (which is what Angelina Jolie received).<\/p>\n

Angelina’s surgery – is public – as she wanted it, and in this blog I paraphrase highlights from Angelina’s general surgeon (breast surgeon). \u00a0I think it is wonderful that she is sharing and I think she made a good decision based on the knowledge that is available.<\/p>\n

In Summary of Angelina’s surgery:<\/h3>\n

My one sentence summary of her recent breast surgeries from February 2013 to May 2013:<\/span><\/em><\/p>\n

With a known BRCA1 genetic mutation, Angelina Jolie underwent a prophylactic nipple sparing double mastectomy with sentinel lymph node marking after passing a nipple delay surgery procedure, and then had a staged plastic surgery breast reconstruction procedure involving breast expanders and implants.<\/p><\/blockquote>\n