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by Charlotte Andersen for SHAPE.com
Angelina Jolie has always been a trendsetter, and now she is using her powers of persuasion to bring awareness to a very sensitive topic with her announcement in yesterday's New York Times that she had a prophylactic (preventative) mastectomy and breast reconstruction surgery after finding out that she has the BRCA1 gene.
The decision was a powerful one on a personal level for Jolie, who had watched her mother fight and then eventually succumb to ovarian cancer. But people everywhere are applauding her for making her choice public as well.
"What Angelina has done is hugely powerful and courageous," says Niki Barr, Ph.D., founder of a psychotherapy practice dedicated to working with cancer patients and author of Emotional Wellness: The Other Half of Treating Cancer. "It encourages women to explore their options and makes this option much more viable."
The BRCA gene increases the risk of breast cancer from the normal lifetime average for most women of 12 percent to 60 to 80 percent, says Adam Hamawy, M.D., a board-certified plastic surgeon specializing in breast reconstruction surgery.
The surgery, which lowers your breast cancer risk to less than 5 percent, can be a lifesaver, but the choice is a difficult one since having the gene doesn't mean you'll definitely get cancer. And for all the attention Jolie is bringing to the procedure, few people are talking about what you have to deal with post-op. Before considering this major surgery, you should consider the following things.
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1. It's not for everyone. "The gene mutation is actually quite rare," Dr. Hamawy says, adding that it's a very personal decision that a patient needs to discuss extensively with her doctors and a genetic counselor. Dr. Barr also worries that while Angelina's choice will empower many women, it may also lead some to have unnecessary surgery by overestimating their own risk. "Now women see someone glamorous and beautiful doing it, and there's a risk of people jumping on the bandwagon who may not actually need the surgery," he says.
2. When it comes to surgery, you have options. Jolie chose to get implants, but you can also use your own body tissue. Another choice is to simply choose to have the mastectomy without having reconstruction surgery, although Dr. Hamawy doesn't recommend this option unless a patient feels very strongly against it. "Research has shown that women who get reconstructive surgery have a better quality of life going forward," he says.
3. It's not a single surgery. Dr. Hamawy explains that "breast reconstruction" is actually a series of surgeries, each with their own risks and recovery times, and you should expect it to take at least six months until recovery is complete.
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4. It's not a cure-all. While the surgery lowers your risk of breast cancer substantially, Dr. Hamawy cautions that you still need to be vigilant by keeping up with your self-exams and doctor check-ups.
5. It's a loss. "It's not uncommon to be totally confident in your choice to have the surgery and then fall apart afterwards," Dr. Barr says. "All of the emotions kind of catch up with you after surgery, and you go through a grieving process. It's a real loss and sometimes this catches women by surprise. On one hand if feels like something concrete they can do to protect themselves, but on the other hand this is something they'll be dealing with the rest of their lives."
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