She will undergo reconstructive surgery over the next eight months. "I'm going to have cute boobs 'til I'm 90, so there's that," she joked during an interview on a US talk show. "I'll have the best boobs in the nursing home. I'll be the envy of all the ladies around the bridge table."
The 36-year-old actress elected to remove both breasts even though the disease was contained in one breast. She said she is now cancer-free.
Applegate called the operation a logical decision. Her mother battled breast cancer, and she tested positive for the BRCA1 gene mutation linked to breast and ovarian cancer. "I just wanted to kind of be rid of it," she said. "So this was the choice I made and it was a tough one."
The experience has been an emotional roller coaster, she said. "Sometimes, you know, I cry and sometimes I scream and I get really angry and I get really like, you know, into wallowing in self-pity sometimes," she said. "And I think that's - it's all part of healing, and anyone who's going through it out there, it's OK to cry. It's OK to fall on the ground and just scream if you want to."
The Samantha Who? star has kept her sense of humour intact. "I've laughed so much in the last three weeks," she said. "I love living, and I really love my life, and I knew that from this moment on it was only going to be good that was going to be coming. Yeah, I'll face challenges, but you can't get any darker than where I've been. So knowing that in my soul gave me the strength to just say, `I have to get out there and make this a positive'."
Applegate's cancer was detected early through a doctor-ordered MRI. She said she's starting a program to help women at high risk for breast cancer to meet the costs of an MRI, which is not always covered by insurance.
What is a mastectomy?
"The treatment of breast cancer depends on a variety of things, such as the stage of the cancer, the type of cancer, as well as the patient's age and wishes," says Dr Jenny Edge, Cape Town surgeon and breast cancer specialist.
There are two basic types of treatment. The one is local, and involves surgery and radiation, both of which are aimed at removing and killing the cancer cells in the breast, lymph nodes or other target organs.
The other is called systemic therapy, which describes treatment that involves the whole body. This is usually in the form of hormonal therapy or chemotherapy.
Stage one of the disease is treated locally (usually surgery) and sometimes also hormonally. Stage two of the disease is treated with surgery first, followed by systemic treatment.
Treatment for stage three of the disease is mostly treated systemically first and then with surgery. Stage four is usually treated systemically. Radiation may be used to treat spread to the bones.
What types of surgery are there?
Three issues need to be considered when deciding on breast surgery: the treatment of the breast itself, the treatment of the lymph nodes and the question of reconstruction.
Radical mastectomy means the removal of all breast tissue and entails the removal of the breast, underarm lymph nodes and the chest muscles under the breast.
"But, because of the disfigurement and side effects, and because modified radical mastectomy has proved equally effective, radical mastectomy is now rarely done," says Edge.
Modified radical mastectomy involves the removal of the breast tissue, the fascia on top of the muscle and the lymph nodes. The advantages of this procedure are that it is less disfiguring, and can also be done through a small incision keeping the skin, and this allows for immediate reconstruction.
Breast conservation therapy (BCT) can be performed if the tumour is less than 5cm in size. When used with the correct patients, modified radical mastectomy and BCT are equally effective as long as radiotherapy is given after the surgery.
The lymph nodes must be dealt with at the same time. All the underarm lymph nodes may be removed or a sentinel node biopsy may be performed. The sentinel lymph node is the first node to which the cancer usually spreads.
The bigger the tumour, the greater the likelihood is of this happening. A radioactive substance is injected into the cancerous region and is carried by lymph vessels to a sentinel node, which is the first lymph node receiving lymph from the tumour. If this sentinel node contains cancer, more nodes are removed.
The body's lymphatic system is used for drainage – so what happens when these lymph nodes are removed? "The fluid drains through alternative routes. But one has to remember that cancerous tumours block these lymph nodes, so if they are involved, it is better to remove them," says Edge.
Can breast cancer be prevented?
Some women who have several family members who have had breast cancer and therefore have a predisposition for breast cancer, consider having a mastectomy done in order to reduce their risk of breast cancer. Or women who have had breast cancer on one side, consider a mastectomy of the other breast as well.
"Cancer that has spread is always worse than a mastectomy," says Edge. "But, for the general populace, this is certainly not the way to go. If you are at risk for breast cancer, regular mammograms are recommended."
She stresses that choosing a mastectomy is merely a risk-reducing procedure and not a sure-fire preventative mechanism. There are a few women who have a very high risk of developing breast cancer, who will benefit from a mastectomy, but for most women annual mammography is better. Breast reconstruction with implants or prostheses can go a long way to reducing the trauma of having a mastectomy.
Reach for Recovery
Alice Lawrence at 021-480-6153
Sandra Boyd at 021-697-5419
Like B4 Mastectomy Boutique at 021-423-2857.
Sources: Sapa, Health24.com
(Compiled by Amy Henderson, Health24.com, August 2008)