DOUBLE MASTECTOMY, IS ANGELINA JOLIE’ CHOICE HEROIC


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BY ADEYEMI OSHUNRINADE

May 14, 2013

In the book “Saving Love” ‘the Soldier who married a Suicide Bomber,’ Kathy, mother of a U.S. soldier in Iraq, became devastated when she got the news she never wanted from her Oncologist. George her husband, accompanied her to the hospital for a mammogram which revealed she had lumps and breast cancer. The lump was initially found in her right breast but a few weeks after more tests, her doctor found the cancer had metastasized to the left breast. Kathy’s story and that of Angelina Jolie is similar to what women with breast cancer face around the world.

The actress Angelina Jolie announced in a New York Times article that she underwent a double mastectomy to remove her breasts. Jolie learnt she carries a mutation of the BRCA1 gene, which increases her risk of developing breast cancer and ovarian cancer. According to Jolie, her doctors estimated she had an 87 percent risk of breast cancer and 50 percent risk of ovarian cancer.

As a preventive measure, she decided on a double mastectomy after consultation with her specialists to lower the risk as much as she could. Jolie’s mom Marcheline Bertrand, died of ovarian cancer in 2007 at the age of 56, when Jolie was 31-year-old. Her death devastated the 37-year-old actress, who is in a relationship with actor Brad Pitt. The couple has three biological and three adopted children

In Kathy’s case, her doctor indicated that most cases of breast cancer couldn’t be prevented through any action on the part of the patient. According to her specialist, the disease is preventable by reducing alcohol intake, increasing physical activities and maintaining a healthy weight. Kathy, did not drink alcohol, she did her walkout daily and ate healthily so why she would have cancer was beyond her understanding.

Kathy’s doctor wanted to know if she was a smoker but though, she smoked when she was a teenager it was for two years while in High School. A friend of her parents saw her smoking near a grocery store after school one day and the following day she called them to report her. Her father threatened to withdraw her benefits and from that moment on, she stopped and never touched a cigarette again.

The only sign why she would have breast cancer was her family history. Her grandmother had breast cancer but it was not discovered until later in life. She was close to 85-year-old before it got discovered and when she died it was due to natural causes and not breast cancer. Her cancer specialist said that the genes associated with breast cancer syndromes usually increase the risk of getting breast cancer, just as in Jolie’s case.

The risk is higher if a mother, sister, or daughter had breast cancer before the age of 40. Kathy’s mom never had breast cancer and her grandmother did not have it until late so why she would have the disease became unknown. She could not be relieved since being diagnosed and her doctor said she would have to undergo a mastectomy to remove both breasts.

In Jolie’s case we do know her mom died of breast cancer at age 56. There is a family history and her decision to go ahead with a double mastectomy was a proactive one based on her chances of developing both breast and ovarian cancer. It remains unknown how the actress reacted when she first got the news of her susceptibility to breast cancer, but the decision to remove both breasts without actually having breast cancer could only be described as courageous.

The day Kathy got the news about the mastectomy she could not sleep. She cried her balls out and was only able to sleep after taking sleeping pills recommended by her physician. She cried incessantly on George’s shoulder, as she could not imagine having to lose her breasts. She had done everything a mother must do at childbirth to avoid the disease. When her son Jason was born, she made sure he was breast-fed until he was nine months when she decided to wean him before he turned 1-year-old. She could not be embarrassed by Jason sucking on her breast while a toddler so she chose to end it.

Jolie wrote that on February 2, she had a procedure that increases the chance her nipple could be saved. Two weeks after the procedure, she had major surgery to remove breast tissue and temporary fillers were put in place. Nine weeks later, she had reconstruction of the breasts with an implant, a procedure that usually follow after consultation with the patient that involves choosing the best and last fillers to replace temporary ones.

Two weeks before her own mastectomy, Kathy’ physician referred her to counseling which George attended with her. The night before the surgery, she asked George to get a camera and she took about 50 photos of both breasts. She had the photos developed and then kept them in a box in her wardrobe. George could not bear the emotion and had to leave to cry in the bathroom. Kathy had lost her hair due to chemotherapy and both agreed not to tell their son Jason, who was then a soldier in Iraq.

Immediately after Kathy’s mastectomy, her doctor inserted a tissue expander, placed on her chest wall. This created a small pocket to contain the permanent implants. The tissue expander was partly filled with saline and she would have permanent implants within three weeks. Her doctor cleared her for another reconstruction to replace the expander. She chose the saline filled implant over silicon because they met her needs and would make her feel more comfortable without her real breasts.

Describing her mastectomy, Jolie wrote: “I wanted to write this to tell other women that the decision to have a mastectomy was not easy. But it is one I’m very happy that I made.” “My chances of developing breast cancer have dropped from 87 percent to under 5 percent.” The actress shared her experience to encourage other women that might find themselves in same situation. Though, a difficult choice to make, Jolie want women to know it is a safe one.

As for Kathy, she felt more comfortable after her final implants than she had felt with the tissue expander. Though she experienced some tightness and discomfort immediately after the exchange, the surgeon told her it would disappear once the implants have settled and healed which takes two to three months. Two months later, her nipple areola got reconstructed and she had some fat injected to adjust her breast shape to the size that made her comfortable.

After all the surgeries, Kathy’s first sexual encounter with George was weird until she felt completely comfortable with her new breasts. At first she felt shame to expose them to George but when he held them in his arms and wouldn’t let go, she realized how much he loved the feeling of her new breasts. The sensation was not different from when she had her old breasts she thought, as she felt chills run through her body.

While some details of Jolie’s mastectomy are unavailable, the actress probably had similar experience as in Kathy’s case. What Kathy and Jolie underwent is reminiscent of what a woman might experience under same circumstance. Whether her action is heroic or not is a matter for future debate. However, it is a courageous move. An act of valor by a woman who given the choice, gave up her body parts to save her life and live for her family. The decision came down to her children and she chose to live for them haven lost her own mom to cancer. “I can tell my children that they don’t need to fear they will lose me to breast cancer,” she said. Yet, there are those who say what if her physician’ predictions are wrong.

Dr. Adeyemi Oshunrinade [E. JD] is the author of ‘Wills Law and Contests,’ ‘Constitutional Law-First Amendment’ and ‘SAVING LOVE’ available at http://www.amazon.com/author/adeyemioshunrinade. Follow on Twitter @san0670.

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