Mastectomy revealed: What women can learn from Angelina Jolie’s surgeon

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After revealing to the world that she recently underwent a preventative double mastectomy, actress Angelina Jolie gave her doctor permission to describe her treatment and surgeries in detail in the hopes of helping other women.

In a post on the website of the Pink Lotus Breast Center, where Jolie had received her care, Dr. Kristi Funk, the centre's founder and a breast-cancer surgeon, explained the step-by-step process that appears to have taken place over a number of years.

In a piece that appeared in the New York Times on Tuesday, Jolie explained that she carries a mutation of a breast-cancer gene known as BRCA1, which dramatically increases her odds of breast and ovarian cancer.

Funk highlights the fact that celebrity status didn't give Jolie special access to genetic screening. Jolie's family history – her mother had breast cancer and died from ovarian cancer, while her grandmother also had ovarian cancer – "would certainly meet any insurance carrier's criteria to cover genetic testing," Funk noted.

Both Jolie and Funk emphasize the fact the actress's decision to have a mastectomy shouldn't influence other women facing a similar situation. Jolie said she wants to raise awareness for women who may not realize "they might be living under the shadow of cancer" and to advocate for better access to potentially life-saving gene testing.

Funk describes Jolie's decision to opt for a prophylactic mastectomy, a procedure that is known to reduce future breast cancer risk to almost zero, according to Steven Narod, director of the Familial Breast Cancer Research Institute at Women's College Research Institute in Toronto.

After making that decision, Jolie also had to decide whether or not to preserve her nipples (she did). She also had to decide whether to have a "nipple delay" procedure to identify whether there was any cancer behind the nipple area. Jolie opted for the procedure and no cancer was detected.

She had an allograft implant reconstruction. Allograft uses donated human tissue that is engineered and processed to remove cells that could cause rejection.

Jolie's first procedure, the nipple delay, took place Feb. 2, while the double mastectomy occurred on Feb. 16. That surgery can last up to eight hours, and during it, tissue expanders were placed behind her pectoral muscles as part of the reconstruction. Funk revealed that she developed a new technique while treating Jolie to inject a dye that would identify any cancer in the sentinel nodes.

The reconstructive surgery took place on April 27 and the tissue expanders were replaced with the allograft implant.

Jolie has won praise from many medical experts for her decision to go public and help raise awareness of genetic mutations that put women at greater risk of breast and ovarian cancer. But she has also faced a negative reaction from journalists and online commenters who say she will start a stampede among women demanding access to the gene test or preventative mastectomies.

In Canada, testing for BRCA mutations is widely covered, although experts agree that access to treatment may not be equitable in all provinces and in some remote or rural geographic areas. Women who meet certain criteria, such as a close family history of breast and ovarian cancer, would receive the gene test.

Many doctors say the real problem is that not enough women who carry the BRCA mutations are aware they exist.

Women with mutations of BRCA1 or another gene, BRCA2, have between a 40- to 85-per-cent chance of developing breast cancer in their lifetime. Women with a BRCA1 mutation have a 25- to 65-per-cent chance of ovarian cancer, while women with BRCA2 have a 15- to 20-per-cent chance of ovarian cancer.

Women may carry a BRCA mutation if they have certain characteristics, notably a family history of breast and ovarian cancer or family members whose breast or ovarian cancer was diagnosed before age 50. People of Ashkenazi Jewish descent also face a heightened risk.

It's important to note that BRCA mutations are only responsible for a fairly small percentage of breast and ovarian cancers, overall. About 5 per cent of breast-cancer cases and between 4 and 11 per cent of ovarian cancer cases are linked to mutations of the BRCA genes.

But for women with the mutations, the risks are significant. And many women have no idea that they carry the mutation.