TV personality Giuliana Rancic announced Monday she's decided to have a double mastectomy after undergoing a double lumpectomy for breast cancer.
Rancic's husband Bill told the "Today" show that despite having the lumpectomies not all cancer cells were eradicated. That prompted the decision to forgo yet another lumpectomy and radiation and try a more drastic approach.
Whether or not a woman decides to under go a double, or contralateral, mastectomy depends on a number of factors, said Dr. Gregory Senofsky, breast cancer surgeon and assistant director of the Margie Petersen Breast Center at Saint John's Health Center in Santa Monica. Those can include having cancer that is too large to be treated with a lumpectomy, having cancer in different areas of the breast or having a BRCA 1 or BRCA 2 gene mutation, which can greatly increase the risk of breast and ovarian cancer.
Immediate reconstruction surgery following a mastectomy is often recommended, although not all women take advantage of it. There are both physical and psychological advantages, Senofsky said: "If you don't do it immediately you need a lot of extra skin to get a good closure, since the skin wrinkles up and becomes unusable for future reconstruction."
Some studies have shown that having reconstruction can make women feel more confident and have a better self-image.
While having a double mastectomy can greatly reduce the chance of cancer recurrence, it's not a guarantee. A patient's prognosis may depend on the type of cancer, whether it's spread to the lymph nodes, and how aggressive it is.
Some women opt to have a prophylactic double mastectomy when cancer is not found in the other breast. A 2007 study in the Journal of Clinical Oncology found that among 152,755 women diagnosed with cancer in one breast, 4,969 chose to have the procedure. Women who have cancer in one breast have a higher risk of developing cancer in the other breast; that fact compels some women to decide to have both breasts removed as a precaution.
The study found the rate of prophylactic double mastectomies went from 4.2% in 1998 to 11% in 2003.
Even after a double mastectomy, cancer can return in other areas of the body, Senofsky said, such as the bones, liver and lungs. "Fortunately for cancers that were caught early," he added, "that rarely happens. Occasionally it can also come back in the muscle and skin [of the breast], but that's a very rare event that I've seen."