October is the annual campaign to increase awareness of this disease. Many of us have family and friends who have been diagnosed with breast cancer. Some are survivors, others we lost. It is always a devastating diagnosis. Women are faced with making health decisions to deal with their cancer. Choices are usually a lumpectomy or a mastectomy.
A lumpectomy, a procedure to remove detected lump(s), is usually performed when the cancer has been detected but hasn’t spread. A mastectomy is a procedure to remove the breast, either a single or double removal. According to the Mayo Clinic “Deciding between a mastectomy or a lumpectomy can be difficult.” With a lumpectomy there can be some deformity of the breast, especially when combined with radiation therapy. A second procedure called oncoplastic breast reconstruction can help if that occurs. It can be performed at the same time or later. The earlier the detection, the better chance of survival.
This difficult decision isn’t just for women having a cancer diagnosis. Some women with a strong family history or who have certain genetic mutations increasing their risk of breast cancer may face a choice called “prophylactic mastectomy.” This procedure is usually reserved for those with an extremely high risk of breast cancer. Whether diagnosed or seeking a preventive procedure, losing breast skin, nipple appearance, and breast sensation becomes a consideration in what, if any, procedure to seek. In a joint interview with Dr. Anne Peled and Rohnert Park resident Violet Page of October 16, a recently developed procedure was discussed.
Peled is Co-Director, Breast Cancer Center of Excellence, with Sutter Health’s California Pacific Medical Center in San Francisco, CA. In addition to her medical practice, specializing in breast reconstruction and plastic surgery, she is also a breast cancer survivor. At the age of 37, she discovered a breast lump. It wasn’t benign, she had Stage 1 breast cancer. She then had to make her own difficult decision. She chose the lumpectomy and oncoplastic reconstruction route, partly because of the concern for loss of sensation. She knew firsthand that most women experience chest numbness after surgery. She wanted to change that. So, with her husband Dr. Ziv Peled, another board-certified plastic surgeon, she pioneered “an entirely new way of treating breast cancer with a combined mastectomy and reconstruction technique that preserves the nipple, the skin and the sensation” of the breast.
Page was Peled’s 100th successful procedure. She lives in the E Section of Rohnert Park and is attending Sonoma State University studying psychology. She knew her family had a “strong and aggressive history of incredibly young breast cancer.” Her grandmother and aunt both died in their mid-thirties. This led her to pursue genetic testing when she was just 19 years old. She found out that she carried the harmful BRCA-1 genetic mutation. That mutation brought her risk of developing breast cancer during her lifetime to around 87 percent. It also increased her risk of ovarian cancer to between 40-60 percent. Those scary numbers convinced her it wasn’t a matter of “if” she would develop cancer but “when.” She watched her Aunt Jen battle metastatic breast cancer for five years. She then decided to do everything possible to beat cancer before it had a chance to beat her.
Page had to advocate for herself. Doctors and friends told her she was too young. That undergoing a “prophylactic mastectomy” was just too radical. Wait until she was 25 to decide. But she persisted. As she said, “this is what I need to do.” That’s when she connected with Peled and her new sensation saving mastectomy procedure. Her operation in June was a three-hour procedure with an overnight stay in the hospital. It was followed by six weeks of recovery at home. Her mom, visiting for five days and her boyfriend attended her during her recovery. The first few days were a bit rough dealing with pain and restrictions such as sleeping on her back and no lifting. But after a few days, she was off her stronger pain medications and able to use over-the-counter pain medications as needed. By the eighth day, she resumed normal, if light, routines around the house.
Page estimates she’s back to about 75 percent sensation. She said she feels like normal. There are still random nerve twinges and pain and it’ll likely be 3-4 months before the tingling completely goes away. Page may have been the 100th patient, but Peled does about 20 procedures per month using this new technique. Peled said the success rate has been 90-95 percent but expects that to rise. Some patients need to complete their radiation or chemotherapy, which impacts on breast nerves, before they also benefit from the new procedure.
For more information, Peled is available at: firstname.lastname@example.org. She also encourages folks to “really take the time to do your research” and recommended a Facebook group “The Breasties” as another resource. Page is hopeful that by telling her story, other young women who are also at high risk will know that pursuing “genetic testing is really important.” She said, “advocate for yourself.” That it was important to stay ahead of the disease, even at a young age.