Prophylactic Nipple-Sparing Mastectomy with Direct to Implant Breast Reconstruction
My name is Melanie and I am writing this two weeks after surgery with Dr. Chrysopoulo at PRMA. Like so many others, I feel so grateful to Dr. Chrysopoulo. I’m so glad I came to San Antonio to do this surgery. I feel great, and once my incisions heal, I’ll have no visible scars. I love how I look, like myself, only better/”perkier."
I have known since 1997 that I have the BRCA1 gene that predisposes me to both breast and ovarian cancer. I was 33 years old when I did that genetic testing. I was young, healthy and single. Despite lots of cancer in my family (my Mom has had breast cancer three times and ovarian cancer once, and she’s alive! My Dad died of renal cancer when he was 50), I honestly thought, despite “having the gene,” it wouldn’t happen to me. I also couldn’t contemplate “cutting off my breasts,” when I was so healthy and single. Because I knew I was BRCA1+ though, I kept up with my mammograms and breast sonograms, pelvic sonograms and CA-125 tests.
In April 2012, when I was 48 years old, my CA-125 was elevated. I remember I was out riding my bike when I got the call. I started to shake when my doctor told me my CA-125 was 164. It had always been around 14 before. My urine had been smelling strange for a couple of months, but I couldn’t figure out why. I had no other symptoms. Within the week, I went to a gynecological oncologist. He said, “That’s not a very high number. High is 900, or 3000.” He examined me and said, “I doubt it’s cancer. But you know what they say with BRCA1, you’ve got to get it out.” My husband and I agreed to go out to lunch, come back to the emergency room, I’d get admitted and have a total robotic hysterectomy the next day.
The surgery went well and I recovered easily, but within a few days learned I did have cancer—transitional cell carcinoma in my left fallopian tube. It was just starting to spread to my left ovary. Because that’s an unusual kind of cancer, and because of my genetic status, and because no one had expected to find cancer, so I hadn’t been staged during surgery, we all agreed I should do chemo, but weren’t sure which drugs would be effective. My husband and I went for a second opinion to MD Anderson in Houston.
That visit was wonderful and affected the course of my treatment. While there, I met with a geneticist who said, “When you’re done with treatment, you really ought to consider prophylactic mastectomies and reconstruction.” She said the surgery is “evolving rapidly,” and there are now “new options that didn’t exist even five years ago.” She told me about FORCE (Facing Our Risk of Cancer Empowered, www.facingourrisk.org) and there I saw an ad for PRMA.
When I first looked at the pictures on the PRMA website, I could see both from the photos and the tone of the website, that the doctors at PRMA were not simply out to save the woman’s life, but to help her regain a sense of herself. The other sites showed scars and results of surgeries that to me looked barbaric and cruel. Having watched my mother go through mastectomies and reconstruction and having seen friends’ scars, I kept feeling like, “I don’t want to put myself through that.”
The issue came to a head when I began to really consider the surgery. Having cancer was so hard! Chemo and then second-look surgery 6 months ago were both very challenging for me physically and emotionally. I can write that sentence now, but if you’ve been through it, you know that one sentence summarizes months of feeling bad, not at all like your true self. My feeling completely changed from, “I don’t want to put myself through mastectomies prophylactically,” to “I don’t want to go through cancer ever again if I can help it.” I knew by having the hysterectomy my risk of breast cancer had decreased, but doctors were saying it was still somewhere between 70-85% chance I’d get breast cancer, too.
I'd like to live a long life. I have work to do. I love my husband very much and want to live a long time. He reassured me that he “wants decades” with me (that felt so good!) and that me having implants would not affect his feelings for me. He said he’d prefer me alive. Me, too.
I met with two teams of surgeons at top hospitals in Los Angeles, and they said things like, “It can’t be done,” (in one surgery). “They’re just telling you what you want to hear.” I began to doubt my decision. They insisted on doing the surgery with skin from my thighs, stomach or back, with expanders, then swapping the expanders for implants, then tattooing the areola and maybe making a “nipple” somewhere down the road. They pushed for a sentinel node biopsy, which I didn’t want because I’m already learning to cope with lymphedema in my legs and didn’t expect to find breast cancer.
I did more research online and saw that PRMA and Dr. Chrysopoulo kept being mentioned by many, many women who’ve traveled to San Antonio to do various kinds of breast reconstruction. Everyone had a positive experience. This reassured me.
At that point, I flew down to San Antonio and met in person with Dr. Chrysopoulo. He had already taken a lot of time to answer all my questions by phone. When I met with him in person, he was so warm. Brilliant and an excellent listener, he was able to explain exactly how he’d do the surgery. He kept saying, “Nope, you don’t need several procedures.” “Nope,” he could keep my skin, areolas and nipples alive and connected to their blood supplies, and this despite a scar from a prior biopsy which other surgeons had said would make skin-sparing impossible. “Nope,” I didn’t need to have any visible scarring, and he’d make the incision “just a smidge,” above the inframammary fold, so if I chose to wear a bikini in the future, and the bathing suit rode up a little, no scar would show. “Nope,” I didn’t need to do a sentinel node biopsy; we could always go in and do that later through my armpit if the pathology came back and happened to unexpectedly show cancer. None of the other doctors had talked this way. I felt profoundly like Dr. Chrysopoulo was able to put himself in my shoes and sense how I’d want to live and look after the surgery.
I was delighted.
His empathy is profound. His emotional intelligence is off the charts. He was confident, but not even remotely arrogant. I felt he was part of my healing team, not an expert who would swoop down, wreak havoc on my body using the latest techniques, and yes, maybe save my life, but leave me with ongoing consequences. On the contrary, I felt he is a deep human being who has taken his years of training in several areas (not only breast surgery but burn treatment and hand surgery, too) and integrated all his learning with a very real sense of the impact of his work on our bodies and our lives. You can probably hear that this is high praise coming from me!
Dr. Chrysopoulo and the whole process of this surgery has exceeded my hopes. His nurse Denise is wonderfully compassionate as well. All the nurses at the hospital were attentive and kind. Everyone at PRMA has been great.
Like so many others, I’m very happy I chose Dr. Chrysopoulo and PRMA to do the surgery.