The Facts About Angelina Jolie's Double Mastectomy

One in eight women will develop breast cancer, and many of us know at least one person who has battled the disease. The news broke recently that film star Angelina Jolie had a double mastectomy this year, meaning she had both breasts completely removed, in order to avoid breast cancer.

Why was this necessary?

Some cancers occur more often in people who have a faulty (or ‘mutated’) gene. For example, people with faults in the Breast Cancer I or 2 (BRCA1 or BRCA2) genes have a greater chance of developing breast and ovarian cancer than those with a normal gene. 

Miss Jolie had a family history of cancer – her mother developed breast cancer, and both her mother and grandmother died of ovarian cancer.It was found that Jolie had inherited the faulty gene and therefore had a much higher risk of developing breast and/or ovarian cancer like her Mom, than women without the faulty gene. 

The only way to reduce the risk is to remove the tissue in which the cancer develops – the breasts and the ovaries.

Is she entirely risk-free now?

No, the risk can never be completely eradicated as it is impossible to remove every last bit of tissue – particularly in the case of the breast, and she still carries the ‘faulty’ genes.  But her risk of breast cancer is now much less.  She will probably have her ovaries removed before she is 40 to reduce her risk of ovarian cancer too.

In 2-8% of cases of mastectomies like Jolie’s, they find that breast cancer is already present. But Jolie’s surgeons were very careful to check that the tissue removed was still healthy, and also checked out and marked the closest lymph nodes.

Why are lymph nodes important?

The lymphatic system is composed of vessels forming a network all over the body which carry a substance called lymph. Fluid from the cells of the body drains into the vessels , which filter it though small nodules called lymph nodes.  The lymph nodes contain specialized white cells able to deal with any infecting organisms found in the fluid.  When you have an infection such as a sore throat, you may be able to feel the lymph nodes in your neck, close to your lower jaw, as they swell when fighting infection.

In the case of Angelina Jolie, the surgeons traced the nodes nearest the breast (often found in the armpit) and found them to be clear of cancer. But they also marked them so they will be easier to find in future, so that if she does develop breast cancer they can easily recheck the nodes.

Reconstructive Surgery Following Mastectomy

Like many women who have mastectomy, for prevention or treatment of breast cancer, Jolie decided to have her chest area reconstructed, so that she had the appearance of breasts again.  This can be done at the same time as the mastectomy, but Jolie opted to wait a couple of months before reconstruction.  Dr. Kristi Funk who treated Jolie at the Pink Lotus Breast Center in Beverly Hills, USA explained that this delay produces better cosmetic results. 

In Jolie’s procedure they preserved her nipple tissue, having checked in an earlier procedure that it was free of cancer.  She had her own breast tissue removed through incisions under the breast.  During reconstruction she had teardrop-shaped breast implants inserted, which were supported by special tissue slings, for a natural appearance.

Assessing your own risk

With breast cancer now being such a common disease, many women are worried about developing it.  Breast cancer screening programs operate in a number of countries and it is advised that women over 50 have regular mammograms, as the scans are called.  While breast cancer most commonly develops in women over this age, increasing numbers of young women are being affected. Having faulty BRCA genes increases the chance of developing breast cancer below the age of 50.

 So it is important for all women to look out for warning signs.

It is a wise precaution for all women to check their breasts regularly (at least monthly) and be familiar with their size shape, weight and appearance, so that you will readily pick up on changes. (See Links below for breast self-examination instructions if you are unsure how to carry this out).

Familial or genetic risk

It is estimated that only 5-10% of cancers are actually caused by a faulty gene or inherited risk, but if you are worried that you may be at risk, you could look at an online assessment tool called OPERA, by the British cancer support charity Macmillan (see Links below).  This assesses risk based on your personal and family history of cancer and only involves 9 quick questions.  (Don’t be surprised that you will be asked about male relatives with breast cancer, as although less common, it does occur in men).

If you feel you are at high risk for breast cancer, you should speak to your doctor, who could refer you for genetic testing, as happened with Jolie.