Angelina Jolie’s Courageous Decision; But Is It For Everyone?

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by Dr. Steven Wallach

I applaud Angelina Jolie’s decision to share with the world her decision to undergo bilateral prophylactic mastectomies because of her significant genetic predisposition to develop breast cancer. It is certainly not a decision to be taken lightly and not for everyone. I think that with her sharing this with the public is truly incredible, and it increases public awareness of options which is fantastic! However, this decision is not for everyone. She decided that instead of monitoring her breasts with ultrasounds, mammograms, and perhaps MRI’s on a more frequent basis and worrying each time that she would develop cancer, she decided to have nipple sparing mastectomies ( removing about 95% of the breast gland) to diminish her risk over the long term. What it sounds like from the descriptions that I have read is she underwent a tissue expander reconstruction and then an implant exchange procedure. There are many different types of reconstructions and many different reasons why a patient would choose one over the other.

Here are some of the choices:

Reconstructive options include autologous tissue procedures or non-autologous procedures. My preferred are autologous reconstructions. Autologous reconstructions use your own tissue to recreate the breast. These are operations that use your own tissue for the reconstruction; this includes: pedicled flap reconstruction such as with the latissimus dorsi (LD) muscle flap (tissue from your back) with/without an implant, or the pedicled transverse rectus abdominis myocutaneous (TRAM) flap (muscle and tissue from your abdominal region). There are also free flap breast reconstruction options (tissue moved on its own blood supply from another area of the body). The common free flaps for breast reconstruction include: the deep inferior epigastric artery perforator (DIEP) flap, the intercostal artery perforator (ICAP) flap, the inferior gluteal artery perforator (IGAP) flap, the superficial inferior epigastric artery (SIEA) flap, the superior gluteal artery perforator (SGAP) flap, the free TRAM, or the thoracodorsal artery perforator (TDAP) flap, to name a few. Non-autologous breast reconstruction refers to breast reconstruction performed with tissue expanders and breast implants. ( This is what Angelina Jolie had done) One reason may be that she was very thin and didn’t have enough donor autologous tissue to use This is sometimes combined with local muscle flaps, usually the LD flap so that there is adequate skin and soft tissue coverage of the implant. Of course as with all the other procedures, if the nipple-areola complex was removed with the mastectomy, this would need to be reconstructed at a later time. Patients usually stay in the hospital for a few days after the initial procedure. The second stage for exchange of the expander to an implant can usually be performed as an outpatient. Sometimes direct to implant reconstruction can be performed without a tissue expander placement. New York City (NYC) Breast Reconstruction procedures, we hope that you will not hesitate to contact our Manhattan offices at (212) 861-6400 or by mail at 1049 5th Avenue, Suite 2D in New York, NY 10028; or using our contact form to request additional details.