Angelina Jolie Decision: A Plastic Surgeon's Thoughts

As many already know, famed Hollywood actress, Angelina Jolie, recently underwent double mastectomy as a result of finding out that she was positive for the BRCA-1 gene. This gene, which is often found in women with a strong family history of breast cancer, puts her at significantly higher risk of developing breast cancer (as well as ovarian cancer) over her lifetime. By my understanding, Ms. Jolie had an over 80% chance of developing breast cancer, and about 50% chance of developing ovarian cancer by her particular profile. In addition, Ms. Jolie’s mother also died of disease (ovarian cancer), at a relatively young age (and very recently, her aunt died as well), which I am sure put added pressure on her to do something proactively to help combat the disease. I am sure it is never an easy decision to undergo a mastectomy for a women, especially when there is no cancer in your breast, but seeing her mother suffer and eventually succumb to this terrible disease most certainly influenced Ms. Jolie’s decision a great deal. I understand that having seen many of my patients go through a very rough ride with cancer, to say the least. I am not an expert in breast cancer treatment and prognosis, and as such, I can’t really comment whether the decision that Ms. Jolie made was the ‘correct’ one. The fact is no one can. Some very unscrupulous media sources, most notably Mike Adams from the site Natural News, severely criticized Ms. Jolie's decision, calling it a win for the 'Medical-Industrial Complex.' To be sure, I have no respect for people like Mike Adams, as they highly conspiratorial and prey on people's fear of the unknown as well as their general distrust of technology. This is a very effective media gimmick, which has made people like Adams both rich and popular, selling 'natural' cures 'they' don't want to you know about. Sadly, there have been (and always will be) soul-less hucksters of Adams' kind who find a situation like Ms. Jolie's a perfect opportunity to expose themselves as the unethical attention whores they really are, and never have a chance to talk about the important issues that face any woman, indeed anyone (spouses included) who have to face this difficult decision. Likewise, the idea that money plays an over-arching and dominant role in the decision making process to perform the surgery (as is the suggestion by the Mike Adams' of the world) is a specious and factually bankrupt argument as well. After all, Angelina Jolie and her husband (Brad Pitt) make millions and millions of dollars for every movie that they make. There is no way that any of us can go back in time and see if she would have developed breast cancer if nothing else was done, or if she only took vitamin D and drank kale juice smoothies (as someone like Adams would suggest). The reality is that doctors and patients can only make the best decision that they can at the time, and unfortunately, none of us has perfect knowledge. That being said, living in constant fear of developing breast cancer, and knowing that it could be fatal, is not a way to live either. Likewise, wanting to be around for your kids is definitely a good reason to do many things, including a double mastectomy, in this case. So, I think personally that Ms. Jolie made a brave decision to address her situation, and as a result, made a statement, which of course, as one of Hollywood’s most famous, successful, and popular actresses, she is no stranger doing. What I can comment on with some authority is that the plastic surgery techniques available to someone like Ms. Jolie are numerous, and have been advancing rapidly over the last several years. Additionally, as a result of federal legislation, reconstruction after breast cancer surgery is NEVER considered cosmetic, but is medically necessary, and is covered under most insurance plans. Apparently, breast cancer testing is not, and that seems to me, something that will need to be addressed in the future, especially if the scientific data ends up supporting Ms. Jolie's decision to undergo mastectomy as safe and effective. Still, many women choose not to undergo breast cancer reconstruction because of both the psychological and physical commitment. For instance, implant reconstruction, which in my opinion, Ms. Jolie would be an excellent candidate for, take 12-16 visits and a few surgeries. In addition, future maintenance work might be necessary if things like scar tissue develop around the implant. For these reasons, and others (which sadly, also simply include the fact that people are not always aware that reconstruction after breast cancer surgery is actually covered!) only about 20% of women ever get breast reconstruction after cancer surgery. I am not sure, as this story is relatively new, and I have not heard much of the details around it, except what I have shared with you, but I hope if there is one thing that will be a positive is that there will be a greater awareness about breast reconstruction in the future as a result of Ms. Jolie talking about her experiences, and perhaps even becoming an advocate for the procedure, if patients want it. Ms Jolie, as one of the premier celebrities on the planet, has a great opportunity to become an advocate for all aspects of breast health and breast care in the face of cancer, and I am sure she will do a great job in that regard. Of course, people make fun of her in the media, and I myself, have commented on her lips, like most plastic surgeons (even though I think they are mostly natural and any touch-ups are beautifully done). I personally believe she does have a big heart, as evidenced by the all the charity work that she does around the world, which she continued do while she was undergoing her reconstruction. This is not only impressive because it is physically difficult, but what Ms. Jolie does is noble. Perhaps I feel this way because I have never really seen any of the movies she has been (Really! I can't remember one!), but the fact remains that I have always been impressed when I have heard her speak out about her charity work, sensing she is not just another celebrity trying to get some camera time, etc. In fact, most people don’t even know she does as much charity work as she does. As a plastic surgeon, I am certainly interested in what she might offer to patients who are going through the trauma and struggle that inevitably occurs with the diagnosis of breast cancer. I think she could really act as a positive force to help bring more light and understanding to patients who are touched by this disease. I am also interested in seeing how patients, especially patients that I have had the privilege of taking care of, will react to this news, and future updates. Likewise, if Ms. Jolie chooses not to undergo reconstruction, I think that would also be a powerful statement that would also be positive because I think it would help build awareness about breast health and breast reconstruction. People would become more informed about all of their options, and would be able to make a much more informed choice in this regard, which I think is one of the most important aspects of the art of healing, not just medical care. _________________________________ I am a board certified plastic surgeon who practices around Chicago, and I also have an office in Glenview. If you would like more information on breast surgery and breast reconstruction, you can contact me at 773.527.5823.