Much has been made of Angelina Jolie’s decision to have prophylactic mastectomies because of the BRCA gene mutation, but hidden behind the headlines is the fact that her option for immediate reconstruction using an acellular dermal matrix internal bra is a relatively recent development. Kudos to Angelina for having the courage to go public with her experience, much as Christina Applegate did a couple of years back for similar reasons. The message within the message of their experience is that improvements in both reconstruction techniques and the use of skin-sparing mastectomy have changed the approach to breast cancer treatment in fundamental ways. In fact, a recent study found that younger women in particular are increasingly likely to choose mastectomy rather than lumpectomy + radiation treatment, known as “breast-conserving” treatment.
The trend toward mastectomy as a preferred option may seem surprising to some, but not me. I see several factors contributing to it: First, the widespread availability of genetic testing for BRCA, though women should consider this only if there is a family history or other specific reason. Secondly, several studies have demonstrated that skin does not have to be removed with mastectomy for most cancers, which leaves an intact skin envelope for a better reconstruction. Third, immediate vs. delayed reconstruction is increasingly being adopted. But last and definitely not least is the use of the internal bra, made of materials such as Alloderm. I recently published a 12-year follow-up case proving that Alloderm is capable of transforming into living, structural tissue that lasts. Combine all these factors and you have a treatment that has definite advantages over a long course of radiation and possibly long-term anti-estrogen therapy.
What’s more, radiation treatment causes permanent damage to tissue, and one recent study found that 1 in 5 women with “breast-conserving” treatment ends up with another operation anyway, often mastectomy. This was most true for a type of noninvasive cancer called DCIS.
Perhaps we should also give some credit to awareness campaigns such as BRA Day, founded on the fact that women have not been given adequate information upfront about their reconstructive options. The take-home message here is to know your options before taking the first step.