Dr. Angela Stanford calls her decision to have a preventive double mastectomy the best she ever made, but because of the reconstructive surgery she got afterward, many of those around her may not know what she went through. "Because I did this over the summer, there's people probably even that I work with that don't know that I did this. There's no obvious change," said Stanford, an associate professor of education at Southern Arkansas University.
Stanford shared her story to help others understand the benefits of the genetic testing that led to her choice, as well as how her breast reconstructions helped her recover psychologically and quickly return to her active, normal life.
Because of an extensive family history of various cancers, and three benign tumors previously removed from different places in her body, Stanford was especially vigilant when, in late 2017, doctors found a tumor, also benign, in one breast.
She was also skeptical of the proposed treatment plan, to remove the tumor and get checkups every three months thereafter.
"Thirty days can make a difference," she said.
It was then that she first looked into being tested for genetic mutations known to predispose people to cancer. With the help of Tammy McKamie, cancer genetic educator with Texarkana's W. Temple Webber Cancer Center, Stanford learned that because of her family history, genetic testing would be completely covered by her health insurance.
Stanford was tested as soon as possible, and the results confirmed her suspicions. A mutation in a gene called CHEK2 meant she was at high risk of developing breast cancer, as well as colon and other cancers. Her new knowledge gave her confidence in deciding what to do next.
"When I got that result, now that I know I have a gene, that's more power. That is power to me. I know," she said. "So then it's like, forget just the tumor. I'm going to be very proactive."
She opted to have both breasts - and her worry about them - removed before they developed cancer, while she was healthy enough to tolerate the procedure and recover from it quickly. Soon she found an oncology team at the University of Arkansas for Medical Sciences in Little Rock to work with.
Reconstructive surgeon Dr. Keith Wolter was part of the process throughout, part of a trend to ensure breast cancer patients are aware of all their options.
"The majority of patients, historically, who have not gotten reconstruction have not gotten it because they were not offered it. So at least for the last 20 years, the focus has been on trying to include a reconstructive component to breast cancer teams," he said.
Though breast reconstruction is not indicated for all women who have mastectomies, its benefits for those who can take advantage of it are clear, Wolter said.
"There's extensive data indicating that breast reconstruction, for many of the patients who go through it, vastly improves their quality of life. It improves their self-esteem. It's an important tool to make people feel like they've recovered from their cancer and can move on with their lives," he said.
Initial procedures to prepare the patient for breast reconstruction take place during the mastectomy itself, and later surgery completes the process. Reconstructive surgeons use either the patient's own tissue or breast implants filled with saline or silicone to create an appearance as natural as possible.
Recent innovations include new materials that can hold an implant in place when it is positioned in front of the patient's chest muscle, rather than the more common method of placing it behind the muscle. Fat harvested from the patient's body through liposuction can be used to reconstruct breasts.
Advances in surgical technique make possible creating realistic-looking nipples out of skin grafts. There are even tattoo artists who specialize in inking nipples with a 3D appearance onto reconstructed breasts.
Between Stanford's mastectomies and her reconstruction surgery, she had weekly injections of fluid to stretch the skin involved. Her goal was to return to her normal appearance.
"I'm an athletic person, so I'm small-framed. I was not a large-breasted woman, but I still want to look like a woman. I don't want to look like a boy. I like to know that when I wear clothes, they wear a certain way. I'm in the professional realm, so I want to make sure I have my presentation of who I am. So I went pretty much right back the way I was," she said.
Stanford praised her medical team, especially impressed by how seamlessly they worked together. Her reconstruction surgery was in late July 2018, and she was back to teaching just weeks later.
"I didn't miss a beat," she said.
Wolter said he wanted every breast cancer patient to know that they are entitled to at least a consultation regarding reconstruction.
"My job is a great job, because for many of my patients, they'll tell me that what I'm doing is a real positive after what's been overall a pretty negative experience in their life," he said.
Stanford agreed.
"There's just something when you're actually faced with it to where you want to be whole," she said. "You want still to look how you see yourself being you."