While breast removal surgery is known to have a positive outcome for breast cancer patients, the decision to undergo the surgery is a personal dilemma for most.

Delve Health Monday, October 21, 2019 - 17:19

It’s a situation that no woman wants to find herself in. However, of the thousands of women who are diagnosed with breast cancer, hundreds find themselves confronted with the choice to undergo a mastectomy (breast removal surgery). For those who do go through with the surgery, how does it impact their lives thereafter?

For Ranjani*, a resident of Chennai, who had been getting routine screenings since she turned 40, the decision to undergo a mastectomy was made with immense support and encouragement from her family.

“‘I just want you here and well’ my husband said to me when he encouraged me to get operated,” she says. “Even my children were very supportive. All of them constantly reminded me that life is more than this one situation.”

Though she had discussed and analysed the circumstances in detail, she wasn’t convinced and remained apprehensive about how the surgery would impact her.

All that changed, however, when she met an 18-year-old woman at the hospital who had undergone a double mastectomy (where both the breasts are removed surgically) for breast cancer.

“Here was this young girl who had so much of her life ahead of her who had taken the decision to undergo the surgery. It gave me some strength, seeing her,” adds Ranjani.

It has now been 16 years since Ranjani underwent mastectomy and she is in good health and extremely chirpy as she speaks to TNM over the phone.

“I was diagnosed in 2004 when I was 43. It started when I noticed something was off and just felt uncomfortable, so I confided in my sister-in-law who encouraged me to get it checked up. I was residing in Bengaluru at the time and we went to MS Ramaiah Hospital. The doctor asked for a biopsy. It was extremely painful… I was pricked about 30 times before they could finally get the tissue sample to send to the lab,” says the 59-year-old woman.

When the results came back, her fears were confirmed. Doctors stated that she had a malignancy in her breast, but were also hopeful that since she had been diagnosed at a relatively early state mastectomy and radiotherapy would help immensely.

But it was a difficult decision for her to make.

“The only thing I kept thinking over and over again was about how I would feel or how things would be if I did choose to undergo this surgery,” she recalls.

Ultimately with the support and encouragement of her family, Ranjani did undergo the surgery and has been healthy since. Years later, she also opted to get a reconstructive surgery done, wherein doctors aim to surgically restore shape and structure to one or both breasts following a mastectomy.

After overcoming her challenges, Ranjani was invited by the doctor who had counselled her to come and interact with other patients who were diagnosed with breast cancer. This became a practice and she soon began to speak informally to other women who found themselves in the same place she’d been earlier.

Today, she speaks to women who are faced with the choice and helps them find the same courage in themselves, telling them, “there is no fear anymore.”

Nagercoil-based Florence Chinnamal’s story was different. In 2003, the now 71-year-old woman lost her husband to a massive heart attack. A short while later, she was diagnosed with breast cancer and doctors told her that a mastectomy would significantly improve her chances of beating the cancer.

She underwent a biopsy, the reports of which confirmed suspicions of her diagnosis, and doctors told her that a combination of the surgery along with chemotherapy would help her have a better quality of life, without having to worry about the cancer.

“At that time, I didn’t think about it twice. My daughters had just lost their father and they wanted me to be healthy and were very encouraging. They wanted me to get the surgery done. My mindset at the time was to be there for them, so I didn’t hesitate,” she says to TNM.

Screening for preventive surgery

In 2013, American actor Angelina Jolie made international headlines when she underwent a double mastectomy after she was found to be at risk of developing breast cancer. Studies done in the years following her decision have revealed that more women were willing to get mastectomies done after the actor spoke publicly about it.

It was around this time that many women also actively sought out information about the cancer and began undergoing screening more frequently. For the then 31-year-old Rachel*, this was just another reminder of how careful she needed to be.

“There’s a longstanding history of breast cancer in my family. My grandmother was diagnosed with it and had undergone chemotherapy and a double mastectomy. My aunt and my mom began taking screening measures seriously after my grandmother developed breast cancer. They both underwent screening regularly and my aunt had a lumpectomy at one point, though it was a benign growth,” says the Hyderabad-raised woman to TNM. A lumpectomy is a surgical procedure wherein doctors remove any lump that has been found in the breast, even if it isn’t necessarily cancerous.

However, it wasn’t until she moved to the US that Rachel seriously considered a preventive mastectomy, after testing positive for the BRCA gene herself.

BRCA (which stands for BReast CAncer gene, can be either BRCA 1 or BRCA 2) are what are called "tumour suppressors" and normally play an important role in preventing breast cancer. However, should a mutation occur in these genes, they will not be able to control the growth of the tumour. Doctors can screen and test individuals to determine if they carry a faulty BRCA gene. In the event someone is positive for the mutation, there is a high risk of them developing breast cancer.

Those with a family history of breast cancer may benefit from getting tested for the BRCA mutation. However, if someone does test positive for the mutation it is merely an indication that they are at a higher risk of developing breast cancer, but it cannot be taken as solid proof that they will most certainly develop it. Those who are considering being screened for the mutation should first ideally undergo a session of genetic counseling so they are more informed about what to expect following the results of the test.

“I think seeing how seriously my mother and my aunt took breast cancer impacted me greatly. I spoke with my aunt about how she felt having to undergo this surgery to remove the lump. All I could think at that point was about how I could also protect myself,” she adds.

While the ‘Angelina Jolie Effect’ may have reduced some of the stigma centred around breast removal surgery, the apprehension still exists for women.

“We now have the technology wherein we are able to screen women who may be at risk of developing cancer to determine whether they carry the BRCA gene, which might make them more susceptible to it. So as a result, someone can choose to get a mastectomy done preventively,” explains Dr Teena Thomas, Consultant Obstetrician and Gynaecologist at Bengaluru’s Motherhood Hospital.

Either part of the breast or the total breast may be removed in such a surgery, depending on the stage of the condition in each individual.

So what makes someone a high risk individual?

“First and foremost is family history; history of women in the family having had breast cancer in particular. If there’s an extensive history of breast cancer in the family, that is usually when a doctor will advise the blood test to determine if someone has the BRCA gene. If that too is positive, we explain to them that this means they are at a higher risk of developing the cancer, though we cannot say with the utmost guarantee that it is going to occur,” says Dr Teena.

However, there is still immense scrutiny attached to the subject.

“There are so many different aspects to it. Society tends to objectify women’s bodies so much and we can see the impact this has on women who think twice about a potentially life-saving surgery and fear what comes after the surgery so much,” says Dr Surya, a general surgeon from Coimbatore. “We need to change this mindset and only then can we find an effective solution,” she adds.

Post-surgery care

Following the surgery, some general care measures are required. There are a set of exercises which may be advised by the doctor in order to prevent scarring. Drains may be left in place for a few days post surgery while the surgical wound heals. A doctor, nurse or other trained medical staff member will teach you how to care for the wounds.

In addition, pain medication must be taken accurately. A person should also be on the lookout for any signs of infection, such as pus from the wound site.

Some people can experience ‘phantom pain’ wherein you may feel as though there is a pain in the removed part. This usually goes away with time, but may require counselling at times.

*Name changed