Advances in plastic surgery
Women today have access to breast reconstruction options that were unavailable to their mothers and grandmothers.
Doctors are increasingly avoiding the use of implants by taking fat from a patient's stomach, upper back, buttock or thigh to construct and shape new breasts. If a woman decides to go with implants, they've been made safer and more comfortable, and surgeons increasingly offer immediate implant reconstruction instead of the traditional multistep process that took months of additional doctor visits.
Cosmetic outcomes have never been better, said Dr. Malcolm Roth, chief of plastic surgery at Albany Medical Center in New York and past president of the American Society of Plastic Surgeons.
"It's hard to believe that implants have only been widely available since the 1970s. Before then, and it's really not that long ago, women were subjected to wearing falsies. The options available today have dramatically improved the way a woman looks after surgery. And with even better microsurgery options on the way, I imagine we'll see even higher numbers of women choosing mastectomy."
One such technique, if put into commercial practice, may raise ethical red flags. According to Roth, doctors are working on a new procedure that would one day make it possible for individuals to donate their excess fat -- similar to the way blood is donated today -- so women seeking a more natural breast reconstruction could take advantage of somebody else's flesh.
"The possibility is being explored with our regenerative medicine task force, and it's very exciting," he said. "If we can figure out how a patient's body won't reject the tissue, I think we'll see even more women choosing preventative mastectomy down the line."
'Pink ribbon' culture
A growing awareness of breast cancer survivorship makes undergoing mastectomy not as foreign or frightening as perhaps it once was. An online search shows a seemingly limitless number of breast cancer support groups, with a growing collection dedicated to women considering preventive surgery.
Dr. Mark Sultan, chief of the division of plastic and reconstructive surgery at St. Luke's/Roosevelt and Beth Israel Medical Centers in New York, said he's seen a 20 percent increase in five years of high-risk, yet cancer-free women coming to his office seeking mastectomies.
These patients often arrive telling him what kind of surgery they want because they've read about certain procedures online, and in many cases, they've viewed hundreds of before-and-after photos as well.
In addition, surgeons are marketing themselves directly to information-hungry patients online. Doctors are holding Twitter chats and creating websites to promote their services. At the Stanford University School of Medicine, a breast surgeon has even launched an online guide to help women decide if preventive surgery is right for them.
Dr. Deanna Attai, a board member at the American Society of Breast Surgeons and Thiemann's breast surgeon in Los Angeles, was heading into two back-to-back surgeries last month when she spoke.
One of her patients, just like Thiemann, had cancer in one breast and not the other.
"This is the American culture," she said. "We want quick solutions, and we expect there's an answer to every problem. In many cases these women don't need double mastectomies, but my job is to listen, make sure they have all the information and give them what makes sense and puts them most at ease."
Which is certainly the case for Thiemann.
"I chose to remove both breasts, even though I'm sure some would say it was a hysterical choice," she said. "I don't have BRCA1 or BRCA2, but I do have two daughters. I wanted to do whatever I could to be around for them as long as possible."