Earlier this month, actress, Christina Applegate announced she'd undergone bilateral mastectomies for breast cancer. She reportedly possess one of the better characterized "breast cancer genes", BRCA1, which puts her at extraordinary high lifetime risks for developing breast or ovarian cancers. From the wire reports, she deferred reconstruction and plans on becoming pregnant after planned chemotherapy.

It sounds like she's received very mainstream advice for treating a younger breast cancer patient, particularly for a BRCA1 carrier. IMO these patients are excluded from consideration for lumpectomy procedures for treatment and should be strongly advised to consider prophylactic surgery on the other breast to maximally reduce lifetime risk of subsequent breast cancers. It's important to make sure patients understand that the highest risk factor for breast cancer is a personal history of breast cancer in the contra lateral breast. In young patients like Ms. Applegate, the math is even more persuasive for aggressive surgery as they have longer life expectancies during which breast cancers can develop. These patients are also frequently recommended to have the ovaries removed, both to suppress native estrogen production (which can stimulate some breast cancers) and to decrease the 40%+ increase in risk of ovarian cancer that brca1 confers.

I'm a little confused why they would not have proceeded with any part of her reconstruction at this point. She's trim enough that I do not believe she has enough bulk to do her reconstruction using her own tissues alone (probably using some microsurgical technique). I'd have strongly advised placing tissue expanders at the time of mastectomy to maintain the skin elasticity and you could later decide if you needed silicone gel implants or you could find an acceptable donor site for some autologous tissue to use. In a low risk patient, you really don't lose much by expander placement, while you realize an easier expansion process.




Rob

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