A drastic decision to beat cancer before it starts - Cape Cod Healthcare

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Published on October 03, 2016

A drastic decision to beat cancer before it startsA drastic decision to beat cancer before it starts

Kathe Medwin of Centerville made a life-changing decision this year when she opted to have both of her breasts removed, even though she didn’t have cancer.

Medwin’s risk for getting breast cancer is high because she has the gene for breast cancer. After learning her sister, who has had breast cancer twice, had the BRCA2 gene mutation, Kathe decided to be tested, herself. The test came back positive for the BRCA2 gene, and, after thinking about it having prophylactic surgery for almost two years, she took a leap of faith.

“It is a very personal decision but it is exactly what I needed to do for me, at the time I needed to do it and where I needed to do it,” she said.

Medwin’s journey began two years ago, with a desire to know what she could do to avoid the disease, and she began with genetic testing. At that time, she had the BRCA1 and BRCA2 testing, blood tests that disclose if you carry one or both of the genes that cause reproductive cancers, such as breast and ovarian, according to the National Cancer Institute.

Statistics show that women who have a positive BRCA 1 or BRCA 2 have a 40 to 85 percent risk of developing breast cancer in their lifetime, according to BreastCancer.org. Their risk for ovarian cancer is 16 to 44 percent, significantly higher than the 2 percent of women with a risk of ovarian cancer in the general population.

Medwin, 55, decided to start by having her ovaries and fallopian tubes removed to eliminate the risk of developing ovarian cancer. Then she met with Kathryn Dalton, DO, a surgeon at Cape Cod Hospital, who specializes in the care of high-risk breast cancer patients.

Cape Cod Hospital now has a high risk breast program at the Cuda Women’s Health Center, and the clinical team there works with women and men to determine their risk for breast cancer.

“Kathe had been followed by me as a high-risk patient for a while before she made the decision to move forward with preventive breast surgery,” said Dr. Dalton. “It is a big decision to have a prophylactic mastectomy.

“For BRCA-positive women, having their breasts removed reduces their risk of getting breast cancer by 95 percent, which makes their risk lower than the general population, which is around 12 percent.”

Medwin and Dr. Dalton discussed options for the surgery including nipple-sparing mastectomy.

“Once I talked with Dr. Dalton about nipple-sparing, that was the icing on the cake,” said Medwin.

“Nipple-sparing is a form of mastectomy, we remove all of the breast tissue, leaving the skin, the nipple and areola intact,” said Dr. Dalton. “The incision is made in the inframammary fold under the breast, the area where an under wire would be if you had a bra on.”

Medwin also met with Michael Loffredo, MD, a plastic surgeon at Cape Cod Hospital, to discuss reconstruction after the mastectomy.

“It is a combined surgery, I remove the breast tissue and Dr. Loffredo does the reconstruction,” said Dr. Dalton.

“We replaced the breast tissue with a silicone implant,” said Dr. Loffredo. “It’s the best cosmetic procedure because the incision is hidden and the silicone implants feel and look more natural.”

Medwin stayed in the hospital overnight after surgery and was discharged home the next day. Recuperation took about six weeks. She will have another surgery in November to complete the reconstruction.

“It is amazing to me that my breasts looked great the day after surgery,” she said. “I had four to five days of discomfort with some difficulty moving around but no pain.

“I’ve had an amazing experience with this and I can’t imagine anything better. Dr. Dalton and Dr. Loffredo are great together, I am very happy that I chose them.”