Some women have a strong genetic predisposition to breast cancer. With the BRCA gene mutation, women have a 70 to 80 percent chance of developing breast cancer over their lifetime and 4o to 50 percent chance of ovarian cancer.
“While only five percent of women possess the BRCA gene, we have identified a good number of patients in Mississippi who have the BRCA gene,” said Dr. Shawn McKinney, a breast surgeon who is a member of the University of Mississippi Medical Center Cancer Institute breast services care team and an associate professor of surgery.
“We get a very thorough history of patients, look for cancers on both sides of the family, and then can determine if they qualify for gene testing for BRCA or other mutations. Usually with the BRCA diagnosis, we would recommend prophylactic bilateral mastectomy before the disease develops.”
One of her patients who qualified for the genetic testing was Artoria Woodson of Fayette. Woodson decided to get genetic testing after reading Angelina Jolie’s story about testing positive for the BRCA mutation and having a bilateral mastectomy followed by breast reconstruction.
Woodson had a family history of breast cancer. Her paternal grandmother, two aunts and sister have had breast cancer. Her mother has had it twice. Woodson also had dense fibrocystic breasts that make diagnosis difficult, and hence she had gone through multiple rounds of abnormal mammograms followed by 3D mammograms, ultrasounds and biopsies.
“I had so many strikes against me,” Woodson said. “When I got tested, I had already said if I had the gene, there was no sense waiting. I had already made up my mind I would go on and do the mastectomy.”
In addition to fearing cancer, she had seen what a toll chemotherapy took on her mother. “I think I feared chemo more than cancer,” Woodson said.
Woodson saw UMMC geneticist Dr. Joseph Maher, and tested positive for the BRCA gene. Then she did a lot of research into her options after the bilateral mastectomy. One involved using muscles from her back to rebuild the breast mound before covering it with skin tissue from her stomach, a DIEP (deep inferior epigastric perforator artery) flap that leaves the stomach tighter and flatter as if you had had a tummy tuck.
Woodson is thin and athletic, and actually had to gain weight to have the surgery. For her, the decision to have the DIEP flap was to improve her recovery odds.
“I didn’t want to deal with implants,” she said. “Just like any transplant, your body might reject it. A lot of people think I did it because it was a cosmetic job. People think I had a boob job and a tummy tuck. There was nothing cosmetic about it.”
Woodson had the two surgeries done at the same time. McKinney did the breast removal while plastic surgeon Dr. Benjamin McIntyre, who is also with the UMMC Cancer Institute breast services care team, did the breast reconstruction.
McIntyre said advantages to using the patient’s own tissue is that it is smoother and very lifelike. While implants are prone to rupture, he said that, after recovery, few women have problems with flaps.
While the surgery and recovery were difficult choices, Woodson said she feels fortunate with the doctors she choose to do the surgeries.
“My doctors treated me like a friend,” she said. “It was really scary, but I really had an excellent team of doctors.”
Woodson had to stay in the hospital for five days after the 13-hour surgeries. But in less complicated cases, many women are having breast cancer surgery today as outpatients. That is particularly true for women who are able to opt for breast conserving surgery.
“We’ve been doing most things as outpatient for a while now especially for women who choose to conserve their breast,” McKinney said. “Even with mastectomies, most times patients only stay overnight unless there is some type of reconstruction, and then they usually stay in the hospital a few days depending on type of reconstruction. For the most part, we tend to get patients out of the hospital as soon as possible.”
Lumpectomies where the cancer is removed but not the entire breast have become more common in the past 25 years because of research trials that showed that, for most patients, the survival rate is the same whether the breast is removed or conserved.
“For me as a surgeon, it comes down to the extent of the disease in the breast,” McKinney said. “If I can I get everything out I need to get out, and leave woman with a cosmetically acceptable breast, they are candidates for keeping their breast.”
Some women are so frightened about the diagnosis of breast cancer that they initially want a mastectomy. McKinney said it is up to her to explore why patients are anxious and then give them concrete data to inform their choice.
“A lot of times people are anxious because they have false information,” McKinney said. “It is up to me to correct the misinformation and give them the correct information and deal with them individually. Some breast tumors are less aggressive than others, and have a better prognosis. If a woman has better-acting breast cancer with less chance of it coming back, then breast conservation is a good option.”
Another option for some women is breast reduction (oncoplastic) surgery at the same time the cancer is removed.
“Some really want their breasts smaller, and may have entertained a breast reduction in the past,” McKinney said. “They may be candidates for breast reduction at the time the lumpectomy done. A plan is made with the help of a plastic surgeon, and we reduce both sides at the time of the lumpectomy.”
Prevention or early detection is still of key importance in breast cancer. McKinney said finding cancer early is always better because there are a lot more options. When caught early, patients are less likely to need additional treatments like chemotherapy or radiation.
“There are some very aggressive types of breast cancer that, even though small, they can still require additional treatments just because of the biology and the aggressiveness of the cancer,” McKinney said.
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