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A SURGICAL OVERVIEW FOR A BRCA2 PREVIVOR

  • Writer: keepingmylife
    keepingmylife
  • Oct 12, 2019
  • 5 min read

First and foremost, since going public with my BRCA2 gene mutation circumstance, I have received an overwhelming wave of support, and for that I sincerely offer you all a heartfelt thank you. So far this journey has been challenging to say the least. The journey ahead will continue to present even more challenging. However, ahead I must continue.


A previvor state of mind.

Previvor! A new word I have learnt during my research. I quite like it, so I am adopting it!


Force defines a previvor as ‘someone who has a predisposition to cancer, however has not developed the disease. Previvors are people who carry a hereditary mutation (such as the BRCA2 gene mutation), a family history of cancer or some other predisposing factor.’


The goal here is to remain a previvor. I must not transition from being a previvor to a cancer survivor.


I will continue to face my risk of cancer being empowered!


BRCA2 positive cancer risks

I mentioned the risks in my first blog, however here is a reminder of those frightening risks as per eviQ:


· 69% chance of developing breast cancer which peaks in the 40’s (I am currently 38!).

· 17% chance of developing ovarian cancer.

· 5% change of developing pancreatic cancer.


We have also learnt that according to the Peter MacCallum Cancer Centre, a woman’s family history influences the risk, in other words, a BRCA2 carrier who had one or more relatives with breast cancer is at higher risk than a BRCA2 carrier with no family history. Keeping this in mind, my sister developed breast cancer, so that along with the gene mutation increases my breast cancer risk alone.


The surgical journey ahead.

According to the Royal Melbourne Familial Cancer Clinic, my breast surgeon and gynaecologist these are the prophylactic surgeries I require to significantly reduce my cancer risk:


· Bilateral mastectomy which reduces my cancer risk by 90%. In other words, removal of both breasts. As breast cancer peaks in the 40’s for BRCA2 carriers, my breast surgeon has recommended that this surgery is done before age 40. She also recommends that I have my sentinel nodes removed. This is removal of lymph nodes in both my armpits which is thought to be where the cancer can either start or spread to.


That places the timing of this surgery to be within 18 months or less for me. Ideally as soon as possible to prevent any pre-cancer cells forming.


· Bilateral breast reconstruction at the time of the mastectomy.


· Bilateral salipingo-oophorectomy by age 45. This is the removal of both ovaries and fallopian tubes. Once this surgery occurs, it will place me into immediate surgical menopause, the side effects of which can be rather intense and distressing! I’ll explore this in a later blog.


· Pancreatic cancer is quite rare. There is a screening research study in place at the Austin Hospital in Melbourne if I wish to participate. No surgery is recommended.


Bilateral (double) mastectomy and sentinel node removal.

So, let’s have a look at the first surgery since this is the most crucial at this point in time. Those of you who have either experienced this or know of a family member or friend who has will understand what is involved, however for those who don’t (like I didn’t until my sister underwent this surgery), let’s explore this now.


This surgery is the removal of both my breasts in their entirety. Yep, my woman hood, my pride, my figure just gone with the slice of a knife so to speak. After having the mastectomy it is expected that I will have numbness and a loss of sensation in the breast area since the nerves that provide sensation are cut when the breast tissue is removed. Some women experience a return of sensation to varying degrees and others none what so ever. I never thought I’d take breast sensation for granted until now so I guess I should enjoy it while I currently have it.


The sentinel nodes will be removed also as when cancer cells begin to spread from the breast, according to the Breast Cancer Network Australia (BCNA), the first place they are usually found is in the lymph nodes in the armpits.


Bilateral breast reconstruction.

Since I am too young, and to be frankly honest, too upset to lose a part of my body which is the hallmark of womenhood, a significant part of me and how I look, I will undergo bilateral breast reconstruction at the time of the mastectomy. I mean, if you were told you had to say bye bye to your potentially killer original breasts, why would you not opt for them to be replaced? I happen to quite like mine the way they are, always have, so I wouldn’t change them if I didn’t have to. I’m a comfortable D cup and I love that.


The BCNA describes the two types of breast reconstruction as:


· Implant reconstruction, in which silicone or saline implants are inserted under the chest muscle to create a breast mound.


· DIEP Flap reconstruction, is deep inferior epigastric perforator (DIEP) where new breasts are formed by moving skin, blood vessels and fatty tissue (no muscle) from the abdomen.


Now, everyone has their personal preference and I’ll tell you what mine is. Personally, I don’t like the idea of having something foreign inside my body if I can avoid it, so that rules out implants. Also, and I won’t go into it, there are some risks with implants such as infection, leakage, rejection that don’t sit well with me.


Ideally, I feel that having the DIEP flap reconstruction is my best option. This surgery uses my own body tissues and will reconstruct breasts that will feel as close to my original ones as possible, which I feel I deserve if I have to go through this. The downside is, since this is major surgery, the recovery I expect is approximately three months. During this time I will be on a strict rest regime.


My plastic surgeon will request that I have a CT scan to assess my suitability for this type of reconstruction. According to Cancer Australia, people who are not suitable have had previous abdominal surgery, have poor blood flow through blood vessels, have chronic medical conditions, are smokers or are very slender. Based on this information, the only set back I have is if I don’t have enough abdominal tissue (fat). I have made a conscious effort not to lose my baby weight like I normally would and will gain a few kg’s if I have to. As my friends have told me, it’s a good excuse to have chocolate cake, am I right? So if you see me about putting on some kg’s, it’s for a good reason. All cake donations will be well received!


Bilateral salipingo-oophorectomy.

My obstetrician/gynaecologist is a wonderful man. I have already established a trusting relationship with him through the birth of two of my three children. I whole heartedly trust him with my life. He has reassured me that he can conduct this surgery and that I may be able to put it off until closer to 45. While there is no recommended monitoring for ovarian cancer, he has adopted a six monthly routine of ovary ultrasounds and blood tests. These can be unreliable, however worth at least doing. My first monitoring session will occur in March 2020 and will continue until I have this surgery.


The surgery itself is the complete removal of both ovaries and fallopian tubes. While the surgery itself is not a worry to me, it is quick keyhole, and has a relatively speedy recovery of about six to eight weeks, it is the after affects that upset me. I will experience immediate surgical menopause. The research I’ve done so far is distressing, so let’s put this one aside for now.


To say I'm absolutely devastated about my gene mutation consequences is a gross understatement. I experience a daily roller-coaster of emotions. However, I know that, in order to keep my life, it is imperative to undergo the surgeries.


And so my journey continues……

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