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Decision to Remove Healthy Breast Is Personal

CancerWise - April 2009

By Bayan Raji

Tamara Barnes

Now in her mid-40s, Tamara Barnes already has beat cancer twice — once as a teenager and once as a mother of two young children.

As a teenager, Barnes had Ewing’s sarcoma, a cancer that affects soft tissue or bone. After 18 months of chemotherapy and surgery, she was cancer-free.

Years later, when her second child was about 18 months old, Barnes had her first routine mammogram. Although the test found abnormalities and lumps in her right breast, Barnes wasn’t worried and neither was her doctor.

But to be safe, the doctor ordered a mammogram and needle biopsy.

Diagnosis is a surprise

The results showed Barnes had ductal carcinoma in situ in her right breast, a diagnosis that caught her off guard.

“It kind of took my doctor and me by surprise,” she says. “We weren’t expecting cancer.”

Initially, Barnes’ doctors hoped a lumpectomy would be enough to cure the cancer. But a biopsy of the tumor showed it was more dangerous than originally thought, so she had radiation after surgery.

Radiation may cause recurrence

According to the American Cancer Society, a number of studies have found that radiation may increase the likelihood of developing cancer. Because of her history with sarcoma, Barnes was worried that radiation for her breast tumor might cause another cancer in the years ahead.

These possible side effects led Barnes to consider the alternatives. She wondered if a contralateral prophylactic mastectomy, or removal of the healthy breast to prevent cancer, along with removal of the cancerous breast was the right choice for her.

“I thought, ‘This is my second cancer, and I’m only 41. For the rest of my life I’m going to wonder if the cancer is back in the other breast,’” Barnes says. “I didn’t want to have to worry like that.”

She comes to grips with appearances

As she considered her options, Barnes realized that not having her breasts was not a big issue for her.

“They are just breasts, and I didn’t really know if the cancer would come back or how serious it might be,” she says. “My kids don’t care if I have breasts or not. They just need me to be here for them.”

For Barnes, a double mastectomy seemed to be the option that would offer peace of mind. She weighed her options and discussed possible consequences with her doctors.

“I think women need to make informed decisions,” she says. “They need to understand treatment options, the pros and cons, and how whatever they choose could impact them. It’s different for every person.”

Surgery removes healthy breast

At first, Barnes’ doctors thought removal of the healthy breast was a radical option. But after she explained the reasoning behind her decision, they agreed with her.

Barnes handled the surgery without missing a beat, even though she had two young children. The most difficult side effect, she says, was being unable to pick up her kids while she healed. Her son was barely a toddler, so it was most difficult for him.

Soon she discovered that, instead of carrying her children, she could snuggle with them or sit next to them if they needed her attention. It took some adjustment for everyone, but it was manageable.

Throughout the surgery and recovery process, Barnes’ mother and friends helped with her children and visited her in the hospital.

Decision is a personal matter

For some women, removing both breasts allows them to breathe a sigh of relief. However, a double mastectomy is not a guarantee that breast cancer will not return. Breast tissue extends beyond what is visible, and the deeper tissue usually is not removed in surgery.

Barnes believes the decision should be an informed one, based on knowledge and not fear.

“Ultimately it’s your choice,” she says. “It’s your body, and you’re going to have to live with it spiritually, mentally and physically. You have to do what’s right for you.”

M. D. Anderson resources:

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© 2014 The University of Texas MD Anderson Cancer Center