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Mutations in the BRCA 1 and BRCA 2 genes can increase a woman’s risk of breast cancer by 60 to 80 percent. Jolie’s risk was amplified by the fact that her mother died from breast cancer at age 56, raising the stakes that she could have a cancer at a younger age.
Jolie said she underwent the surgery to spare her children from the agony she witnessed as her mother struggled with breast cancer for a decade.
That is the case for many women who seek out genetic counseling, said Dr. Susan Klugman, director of reproductive genetics at Montefiore Medical Center in New York, who has done BRCA testing on thousands of women. Klugman said counselors help women work through what it would mean to learn they are positive for the gene.
“Some women are overwhelmed with the information and some women truly feel empowered, said Klugman, adding that she has seen several women in their 30s and 40s with similar risks who chose a double mastectomy as a preventive step. “Angelina Jolie realized her mom died in her 50s. She’s got six kids. She wants to live. These are the stories we see on a daily basis.”
Mastectomies have advanced considerably from the days in which surgeons would remove vast amounts of tissue and skin, leaving women alive but disfigured. Jolie underwent a series of procedures that preserved most of her skin and nipples, while the underlying tissue was removed.
Her doctors also used tissue expanders, which are deflated saline implants that are expanded over a period of several weeks during the recovery period and ultimately replaced by either a saline or silicone implant.
Other procedures can involve the use of tissue from other parts of the body, including fat tissue from the stomach. The whole procedure, including reconstruction, can cost as much as $75,000, according to the American Society of Plastic Surgeons, a cost private insurers generally cover, breast experts said.
“The reconstructions that are done these days are absolutely incredible, which is why I think that many more women choose to have prophylactic mastectomies than they did in the past,” said Dr Sharon Rosenbaum Smith, a breast cancer surgeon at St. Luke’s Roosevelt Medical Center in New York.