about surgery, especially when
the two women are well-matched
in terms of life circumstances and
type of breast reconstruction.
these conversations can also
help women mentally prepare
for what can be a long and
arduous series of surgeries. Many
women considering prophylactic
mastectomy are “very hard-driving, action-oriented people,”
Patenaude says, who view surgery
as a way of being done worrying
about their breasts, once and for
all. (“i’m a sagittarius,” applegate
told oprah, “and we need things
done now. … i wanted to have my
surgery now.”) “well, it doesn’t
work like that,” Patenaude says.
“there is a high complication rate.
there can be multiple surgeries to
have reconstruction.”
Both Patenaude and schover
believe appointments with a
psychologist—before surgery to
aid decision-making, and after
surgery to aid coping—should
be standard. in august 2008,
Patenaude and her colleagues
published a study in the journal
Psycho-Oncology showing that
among women considering
prophylactic surgery, 100
percent believed psychological
consultation would help
their decision-making. “once
somebody brings [psychological
counseling] up to you, it sort of
feels a little bit like a no-brainer,”
Patenaude says. “Like, well yeah!
i’m struggling with this; it really
would be helpful to have a place
to talk about it!”
decisions about prophylactic
mastectomy are often made under
considerable stress. in a situation
such as applegate’s, the decision
comes on the heels of a breast
cancer diagnosis, when women are
under pressure to begin treatment.
in a high-risk family, older sisters
may have already had prophylactic
surgery and be pressuring a
younger sister to do the same.
“Just because it’s the right decision
for several other women in the
family, it doesn’t necessarily mean
it’s the right decision for every
woman in the family,” Patenaude
cautions. For a young unmarried
woman, for instance, it may make
more sense to wait a few years until
she has a partner, or has a chance
to breast-feed her children.
Patenaude’s advice to friends
and family members who want
to help is simple: “no matter how
much you are worried about the
person, try not to pressure them
to ‘just go do it.’ ” Urge them,
instead, to talk to a psychologist
knowledgeable about prophylactic
surgery to sort through their
options—because making
their own decision can be key
to psychological adjustment
afterward. women who most
regret their decision to have
prophylactic surgery tend to be
those who felt pressured into it
by their doctors.
as for applegate, she has no
regrets. “i have taken a very
progressive stance in the rest of
my life,” she told oprah. “For that,
i’m really grateful.” Like many
women, she has experienced an
intense grieving process over the
loss of her breasts, however. the
night before her surgery, she did
her first and last “nudie photo
shoot” at home: “i made sure that
i have close-up photographs of
them from every angle, so i can
kind of remember them.”
PRE-EMPTIVE MASTECTOMY:
MAKING YOUR DECISION
It’s really helpful for a woman facing surgery to speak with
someone who has been through it, says psychologist Andrea
Farkas Patenaude, preferably with a woman who’s well-matched
to her in terms of past treatment and life circumstances (such
as age, marital status, and whether or not she has had children).
“Depending on where one is seen, you might not run into a
doctor who has done this a lot, so they might not have a list
of people who have been through it,” Patenaude cautions. A
helpful resource for information and networking is FORCE, or
Facing Our Risk of Cancer Empowered ( www.facingourrisk.org),
a group for women affected by hereditary breast or ovarian
cancer. It’s possible, for instance, to find women through
FORCE who have already had the surgery. — K.D.
CR | Page No. 33 | www.CRmagazine.org
