Christina Applegate: Pretty Woman after Breast Reconstruction

This week People Magazine put Christina Applegate on their cover of their “100 Most Beautiful People” issue.

Ms. Applegate, 36, known for her roles on Married with Children and Samantha  Who?, has been very open about her diagnosis and treatment for breast cancer. In so doing, she hopes to raise awareness among young women who may not think themselves at risk.

The daughter of a breast cancer survivor, she began mammography screening at age 30. A biopsy of a suspicious spot in her left breast was positive for cancer. She also found out that she was positive for the BRCA1 gene, a gene which gave her an increased of recurrent breast cancer (More about breast cancer genes in Part 2).

Because of this,  she opted for a bilateral mastectomy instead of a lumpectomy and chemotherapy/radiation.  What this means is that surgeons removed all the underlying breast tissue, instead of only the cancerous lump and small amount of surrounding tissue. As she put it:

It just seemed like, ‘I don’t want to have to deal with this again. I don’t want to keep putting that stuff in my body. I just want to be done with this & I was just going to let them go.

At the same time, Christina planned for breast reconstruction, something that many breast cancer survivors have the opportunity to do.
There are many reasons women choose to do a breast reconstruction, including making the breast contour look more even when wearing a bra, and to avoid having to use a breast prosthesis (an insert put into a bra). If no radiation therapy is required after mastectomy, the reconstruction procedure can begin at the same time as as the mastectomy.  Otherwise, breast reconstruction can be planned for later.

Breast reconstruction can be done in a number of ways: with a breast implant, with a tissue flap, or both.

A breast implant is a silicon shell filled with sterile saline (salt water).  Frequently, the remaining overlying skin is too tight to fit an implant.  In these cases, a tissue expander is put under the skin.  The expander is an inflatable pouch inserted under the skin which can be filled over time with fluid to stretch the skin.   Sometimes a series of increasingly larger expanders will have to be placed.  Eventually, the overlying skin is stretched enough so that an implant can be placed. Nipples and areola may also be reconstructed.

In a tissue flap reconstruction, an entire area of skin, underlying tissue and muscle is moved from elsewhere in the body, such as the tummy or upper back, to replace the lost breast tissue.  They act more like regular body tissue in that they can change is size with weight gain or loss, and there is no chance of implant rupture or replacement.

Which type of reconstruction and  what timing is optimal for any particular patient is best discussed between a patient and her physicians.

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Michele R. Berman, M.D. was Clinical Director of The Pediatric Center, a private practice on Capitol Hill in Washington, D.C. from 1988-2000, and was named Outstanding Washington Physician by Washingtonian Magazine in 1999. She was a medical internet pioneer having established one of the first medical practice websites in 1997. Dr. Berman also authored a monthly column for Washington Parent Magazine.

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