Hi sweets!

I was really intrigued by the article this morning (which I think was partially strategy on the part of the NY Times, given the other article their magazine published a few weeks ago, but that’s just me). 

Angelina talks about being BRCA-1 positive, which means that she has a genetic mutation in a gene that, as she said, sharply increases her risk for both breast and ovarian cancer. Women and men with a positive family history for breast or ovarian cancers have an increased likelihood of having a genetic mutation in either their BRCA (BReast CAncer) 1 or BRCA 2 genes. Not all everyone with BRCA1 or 2 mutations develop cancer during their lifetime. That being said, they are still at risk of passing the mutated gene to their kids.

My surgeon’s practice is largely a mastectomy practice. She performs more nipple-sparing mastectomies than the majority of surgeons. Most of her patients are, in fact, already diagnosed with breast cancer, but she does a number of prophylactic mastectomies on patients who have either had suspicious findings on mammograms or (like Angelina) have been found to have a mutation. 

When considering mastectomies, a patient can either have immediate or delayed reconstruction. Angelina’s was delayed, as she elected to have tissue expanders put in place. My surgeon encourages her patients to have immediate reconstruction (unless their is a clinical reason not to, or the patient wants to increase her breast size).

The patient generally spends about 6-8 hours in the OR, where the breast oncology surgeon removes the breasts, and then the reconstructive surgeon comes in to place implants. In Angelina’s case, the reconstructive surgeon placed expanders (which are essentially balloons) under her skin, and she returned to her doctor’s office to have them filled with saline until they reached the desired size. The patient then returns to the OR to have the permanent implant placed. It’s three steps, as opposed to one (the implant placement in the OR), and it allows for a shorter healing time, which is why my surgeon prefers immediate reconstruction.

Most patients are out of work for 6-8 weeks, but of course, each patient is different, and I’ve written up medical paperwork for women who return to work in 4 weeks after having bilateral mastectomies. I promise I’m almost done, as this is getting wordy, but the reconstructive surgery is generally part and parcel with the mastectomy itself, and most insurances generally cover it, especially if the genetic testing proves that the patient has a genetic mutation. I’m no expert on insurances, so I’m speaking very broadly, but a lot of insurances also cover the genetic testing as well, after a prior authorization has been performed. If your insurance doesn’t cover it, the cost of genetic testing does have to come out of pocket.

To wrap things up - at the moment, I see a lot of women treating themselves preventatively and being able to do so as a result of their insurance coverage. However, healthcare is at a turning point, and it will be interesting to see what continues to be covered and what will no longer be. I think I covered everything (and then some)?