My Preventative Mastectomy

@kimberlygeswein

Replying to @twistedtwat this is long but I hope it helps! And I should say I have *a* CHEK2 mutation, not *the* CHEK2 mutation because there are several types. #diepflap #preventativemastectomy #previvor #chek2 #chek2mutation

♬ original sound – Kimberly Geswein 🌟

Genetic Testing

In 2011, my mom was diagnosed with breast cancer. (She’s doing great now- no evidence of disease!)

At the time, we did not have a known genetic mutation in our family. In 2017, her sister found out that she had a CHEK2 mutation (1100delC) and my mom tested and also had the mutation. I chose to do 23&Me testing at that time. I took the raw data from 23&Me and ran it through Promethease and found out that I had the same mutation.

Note: 23&Me’s current chip does not test for the mutation I have and I no longer recommend testing in that way. A physician can order a full panel for you.

Meeting With A High Risk Oncologist

After my annual mammogram in 2020, I had a callback. After my diagnostic mammogram, I was given a referral to a high-risk oncologist to discuss my family history and genetic mutation.

It took me a year to actually make that appointment. In March 2022, I met with the high-risk oncologist and was given 3 approaches to consider.

• Extra screening- a breast MRI in the spring, a mammogram in the fall- with imaging every 6 months, the goal would be to catch breast cancer early if it developed
• Risk-reducing medication- I could take tamoxifen to lower my risk of developing breast cancer.
• Mastectomy- this would lower my risk of developing breast cancer to about 1%.

Why I Chose A Mastectomy

I had really bad back pain after losing over 100 pounds. I still had large, pendulous breasts that were heavy. I no longer had a big stomach supporting those breasts and my back hurt all the time. I needed a breast reduction. I also had a large apron belly from weight loss that was uncomfortable and painful. I had 11 pounds of breast tissue removed during my mastectomy. For me, if I was going to have a breast reduction and a panniculectomy (removal of the apron belly), it made more sense to just have a mastectomy and nearly eliminate my risk of getting breast cancer. I had to weigh all factors, because there are pros and cons with each of the options I was given. Tamoxifen has side effects. The surgeries are expensive and challenging. Extra screening is great but it doesn’t reduce the risk of getting breast cancer, just helps you find it earlier.

Reconstruction

There are multiple options for reconstruction after mastectomy

• Aesthetic Flat Closure- this is complete removal of the breasts with creation of a flat chest wall that is smooth
• Goldilocks- this is similar to aesthetic flat closure but involves using some of the extra skin and tissue to create a small breast mound
• Implants- breast implants
• DIEP flap or other autologous flap procedures- this involves transplanting fat and skin and blood vessels from one part of your body to your chest and must be performed by a highly skilled microsurgeon

My DIEP flap reconstruction

I chose to have DIEP  flap reconstruction. DIEP flap is similar to a tummy tuck in some ways- the plastic surgeons took my abdominal fat and moved it to my chest. It is a major surgery with a significant recovery period, but I knew this was the reconstruction method that I wanted.

In July 2022, I had a mastectomy and had tissue expanders placed in my chest. Those tissue expanders helped create a scar tissue pocket in my chest that gave nice shaping to my new breasts. In January 2023, I had DIEP flap and the tissues expanders were removed and my abdominal fat was relocated to my chest. The scar tissue from the expanders works almost like an internal bra.

If you’re curious, DIEP stands for deep inferior epigastric perforators and that’s the name of the primary blood vessels used in this procedure. There are many other flap procedures that can be done if a patient doesn’t have enough fat in the lower abdomen or has had a previous tummy tuck, including ones from the inner thigh, buttocks, back, and more!