Christina Applegate Discusses Her Breast Reconstruction and Double Mastectomy


Beth Longware Duff, Medical Editor

Beth Longware Duff is an experienced writer and reporter whose work on a wide variety of topics has been published in numerous newspapers and magazines. Her health and medical writing credits include nationally distributed videos for the March of Dimes Birth Defects Foundation, and she is the recipient of numerous awards including an American Cancer Society Media Award and a New England Press Association Award for Health Reporting. She holds a degree in Communications from Ithaca College.

November 21 2008

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Actress Christina Applegate will spend her 37th birthday this month doing something good for herself: recuperating from breast reconstruction surgery following the double mastectomy she underwent over the summer. And, as her gift to other women, she's talking about her experience with breast cancer and breast reconstruction.

"I don't own tomorrow or yesterday - today is all I've got," the Emmy award-winning actress recently told TV Guide. Commenting on her situation, she said, "I still have quite a process until this is done. Yes, it's hard. But I'm not a victim."

She is, however, one of the estimated 184,450 women and men who will be diagnosed with breast cancer this year in the United States, according to the National Cancer Institute, which adds that close to 41,000 breast cancer patients will die from the disease in 2008.

Applegate's odyssey began when she was diagnosed by MRI with an early form of cancer in one breast. She also tested positive for the BRCA-1, a gene mutation that greatly increased the likelihood that she would develop both breast and ovarian cancer.

After considering her options, Applegate chose to have a prophylactic double mastectomy. By removing both breasts, she would be virtually guaranteed that the cancer was completely excised and that the chances of it returning are reduced. Like her mother, Applegate is now a breast cancer survivor, announcing in August that she is "absolutely 100% clear and clean" from cancer.

The actress confirmed her intention to undergo breast reconstruction during a subsequent interview with Oprah Winfrey, explaining that her surgeon had implanted expanders in her chest to initiate the process.

"They have this strange little thing that they insert in there and they keep filling it up with saline to expand behind the muscles," explained the star of ABC-TV's sitcom "Samantha Who?". "They keep expanding over a few months until they take those out and put in your implants."

Breast reconstruction is achieved through several plastic surgery techniques that attempt to restore a breast to near normal shape, appearance and size following mastectomy. According to the American Society of Plastic Surgeons, surgical options available to women seeking breast reconstruction generally involve either tissue expansion to stretch healthy skin to provide coverage for a breast implant or flap techniques that reposition a woman's own muscle, fat and skin to create a new breast or cover a breast implant. Both saline and silicone implants are available for reconstruction. The breast reconstruction process is completed through techniques that reconstruct the nipple and areola.

Despite improved surgical techniques and increased insurance coverage (a right protected by The Federal Women's Health and Cancer Rights Act of 1998), a recently published study revealed that fewer than 20% of mastectomy patients choose immediate reconstruction. "The take-home message is that we're not doing a great job of informing women about all their options," said the study's lead author, plastic surgeon Amy Alderman, MD of the University of Michigan Medical Center in Ann Arbor. "Women and referring physicians need to know that federal law requires insurance companies to cover breast reconstruction surgery in women who have undergone a mastectomy."

Ideally, Dr. Alderman continued, cancer doctors would refer all women considering mastectomies or lumpectomies (the removal of just the tumor and nearby tissue) to plastic surgeons to discuss the benefits and risks of reconstruction and the options available to them. As with all plastic surgery procedures, a well-informed patient is key to a successful outcome.

Applegate has announced that she will start a program to help meet the costs of an MRI, which is not always covered by medical insurance, for women at high risk for breast cancer. She has admitted publicly that her new breasts won't quite measure up to the originals, noting that they will be scarred and shaped differently, and that there will be physical and emotional adjustments she'll have to make during the recovery period and beyond. But she has also stated that she is looking forward to having "cute boobs till I'm 90 – the best boobs in the nursing home" – and she knows that the medical and cosmetic surgery advances that exist today will make that a promise to herself that she can keep.