Does Angelina Jolie paint a false picture of mastectomy?

A woman’s mother dies at age 56. A blood test is done. The woman finds out she has a genetic pre-disposition to cancer. She takes what action she thinks she needs to take. A familiar story repeated over and over again every day. I’ve met many women who have made this choice. While not “normal”, it is a familiar situation. These women’s difficult choices go unheralded. But not Angelina. She has a voice and she’s not afraid to use it.

I am of two minds about Ms. Jolie’s announcement. Unlike double mastectomies for ductal carcinoma in situ (DCIS), which isn’t necessarily a cancer and can be treated with a lumpectomy, BRCA1 gene mutations can’t be treated any other way. Unless I hear differently from my breast surgeon friends, I’d say she probably did the right thing. Her decision to talk about it is probably encouraging to women who have or will have to make that choice. It raises awareness of the gene mutation. It puts breast cancer on the front page of the New York Times. Again.

Here’s my problem: double mastectomy is not a benign procedure. Ms. Jolie seems to have had a remarkably easy time of it. Yes, she says she was right back to her normal life soon after, but since Jolie’s life is not normal that’s hard to generalize. The truth is there is significant pain involved, a long period of waiting while the tissue expanders do their work, then there’s further procedures for the implants, which can develop capsules around them, or rupture, or get infected. If Angelina had chosen breast reconstructive surgery there would be the risk of the flap losing blood flow, multiple drains, overnight stays in recovery rooms or ICUs, and many many surgeries for revision, nipple creation, etc. And the results are not always beautiful. I understand that it is not Ms. Jolie’s role to scare people, but to encourage them. I would just warn against falsely rosy expectations.

I am not trying to discourage double mastectomy. Sometimes it is necessary. I do think that people who have extraordinary access to public attention must pay extraordinary attention to what they say. I wish Angelina all the best for a complete, and beautiful, recovery.

Shirie Leng is an anesthesiologist who blogs at medicine for real.

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  • John Key

    I am not clear on whether she had bilat total mastectomies or if she had subcutaneous mastectomies with implants. Somewhat of a difference in recovery and cosmetic results.

  • Jason Simpson

    I find it funny that an anesthesiologist, who has never performed any kind of surgery, much less breast surgery, somehow feels as if her opinion on the subject is meaningful.

    • adh1729

      She has known hundreds of surgeons in the OR; she has anesthetized countless patients having breast operations (and re-operations); she is (apparently) a woman. I find her opinion meaningful for all of these reasons (and I have personally performed surgery and breast surgery.)

    • Guest

      So non-surgeons should not have an opinion regarding women, breast cancer or mastectomies?

      Grow up.

  • ninguem

    I knew this old lady, a classic old-line New England Swamp Yankee. She had a mastectomy. She wore an insert in her bra to fill out her dresses.

    She’s do her sewing, and used the bra insert as a pincushion.

    There she was, sewing, and pins sticking out of…….

    She said she found the mastectomy very convenient.

  • Mike

    Celebrities paint a false picture of everything. Ms.Jolie also makes it look like it’s easy for an unmarried woman to just run around the world adopting babies at whim. “I’ll take one of these, and one of these, and oh! how aborbs! One of THESE!” Or if you follow celebrities who choose to have children the old-fashioned way, you might think you’ll be back in your pre-pregnancy size 2s within a week of giving birth. There was some Australian singer who had cancer, and she managed to appear glowing and beautiful and perfect all the way through chemo.

    Meh. So whatcha gonna do about it.

  • bill10526

    I am so glad that a lady doctor has shared her benefit/risk analysis of Ms. Jolie’s decision. I believe that Ms. Jolie overstated the benefit and you the risk. I’m just glad that, as a man, I was spared the problem.

    I wish you and Ms. Jolie the very best.

  • Greg Stimac

    I don’t think it paints a false picture for choosing to undergo a double mastectomy. I think it paints a false picture for women who are not informed as to WHY she decided to undergo this procedure. There are different reasons for why breast cancers develop, and Ms. Jolie decided to undergo an operation to prevent her developing just that. Last I read, women with a BRCA1 mutation were 5x more likely to develop breast cancer and ovarian cancer 10x than those without, according to the national cancer institute.

    The fear itself is that women will undergo preventative mastectomies when they straight up don’t need them mostly due to the fact that a celebrity anecdote can be a powerful influence.

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