Many patients get to choose the type of reconstruction they want; for others, the choice is dictated by the person’s size or the type of treatment they need. A patient undergoing radiation, for instance, can have complications from implants.
Teal was a good candidate for implant reconstruction, which involves expanding the skin and replacing breast tissue with silicone gel or saline-filled sacs. She’s thin and didn’t have enough extra tissue in her back or abdomen to be considered for a flap reconstruction. And she was comfortable with the risks: Implants can get infected and harden, which means they have to be removed. They have a 10-to-15-year average life span, so patients can expect additional surgery. She decided on silicone implants instead of saline, she says, because the gel inside feels more like a real breast and is less likely to ripple. Silicone implants were banned in the early 1990s because of concerns about leaks and a possible link to autoimmune disorders and other illnesses. Although research is ongoing, they are now considered safe. Teal has seen them used in many of her patients.
Teal calls plastic surgeon Joanne Lenert “the beautifier.” They’ve worked together in operating rooms for nearly a decade. Dr. Lenert is the one patients count on for a good cosmetic result. Some tell her they want their new breasts to look better than their old ones, perkier and rounder.
Lenert wasn’t shocked when Teal told her she was having prophylactic surgery. She saw her colleague surrounded by cancer patients day in and day out. She could remember three patients she and Teal had operated on together when they were starting out at GW. They were all young women with cancer who’d had mastectomies on one side and left the other untouched. All three later developed cancer in the other breast. Teal told Lenert, “I wish we’d offered to do prophylactic mastectomies.”
Every Monday, Teal meets with radiologists, oncologists, pathologists, genetic counselors, and social workers for something called “tumor board.” They sit at a conference table and discuss all the patients who have been diagnosed with breast cancer that week, usually six to ten people. They look at films and pathology reports, make treatment recommendations, and talk about whether a patient needs extra support. The idea is to get everybody’s input and come to a consensus on the best treatments.
When it came time to discuss her mother’s case at tumor board, Teal hardly said a word. There was no question about what needed to be done: eight cycles of chemotherapy followed by radiation and then Arimidex, an anti-estrogen drug prescribed to postmenopausal women. While McSwain presented the pathology, an oncologist gave Teal a look from across the room, as if to say she understood what she was going through.
The oncologist, Rebecca Kaltman, had lost her own mother to breast cancer in 1998. She was a third-year medical student when her mother was diagnosed with HER2-positive breast cancer, an aggressive form of the disease. At the time, doctors didn’t have a targeted therapy for HER2-positive patients. There was buzz about a drug called Herceptin, which was used to treat metastatic breast cancer, but it wasn’t yet available to patients like Kaltman’s mother. Kaltman called the drug manufacturer from a pay phone at the campus library in the hopes of getting her mother signed up for a clinical trial, but she was unsuccessful. Her mother died 14 months later.
“You know, Becca, I’m doing prophylactics,” Teal said after the meeting. She hadn’t told everybody yet.
Kaltman, 37, was going a different route—staggering MRIs and mammograms every six months, limiting alcohol, exercising and watching her diet. She wasn’t considering surgery. She’d already had a scare and spent an anxious few days waiting for biopsy results, which her husband called the worst weekend of his life, but the close surveillance was reassuring to her. She didn’t mind going into an MRI machine if it meant diagnosing a cancer early. She was treating patients now who had the same type of cancer her mother had, and they were surviving and doing well. But she understood Teal’s point of view: She knew there were high-risk patients who didn’t want to live with all the screening.
“You’re going to help a lot of women struggling with this decision,” Kaltman told Teal.
Teal was happy to hear that. She’d once had a patient who’d watched her mother battle both breast and ovarian cancer; the patient told Teal she was nervous about bringing up prophylactic surgery. Those were the women Teal hoped to reach by sharing her story, the ones who were afraid to talk about it.
Next: "All I want is ten more years."