Phase One And Pause: One Risk-Reducing Patient’s Unusual Decision

“I want to say about two or three summers ago, I was at my GYN for my regular annual. At that point I was just seeing whoever [was available] in the practice. I had my two kids already. I happened to see the nurse practitioner there and she offered genetic testing,” Celeste began.

Celeste underwent genetic testing to assess her reproductive cancer risk. While most patients who undergo this type of testing do so in response to family history of cancer or some other suspicion, Celeste was more or less tested by chance. And the results were surprising.

“When I got my testing back, I was BRCA2 positive, and I was very taken aback.”

Her gynecology office referred her to a breast surgeon and an ovarian specialist to determine the best course of action for her. She and her team put together a plan to monitor her with an MRI, mammograms, and ultrasounds every six months. She felt confident in her decision to watch and wait, unsure of whether risk-reducing mastectomies were right for her. Still, she educated herself on what the surgical process would entail.

As Celeste explored her risk-reducing surgical options, she found both an obstacle and an opportunity. The size of her breasts meant that risk-reducing mastectomies would be a two-stage procedure at a minimum. She would require a lift and reduction procedure first. Then, she could undergo bilateral mastectomies with immediate breast reconstruction. Both procedures felt daunting. Then, she had an idea: why not do the first phase and reassess after that?

“I always toyed with the idea of doing a lift and a reduction anyway, before I even knew I had the BRCA 2 gene mutation.”

Celeste underwent a breast reduction and lift in January of 2024 in an effort to set herself up for future reconstructive success.

“I am very happy that I did it, but I’m still not ready to have the mastectomies. That’s just such another big surgery. I don’t feel ready to do it. I still feel comfortable in the decision I made. If I do decide to do a mastectomy I’m set up to do it, or if something does happen, I’ve already had a first set of procedures,” she explained.

Celeste’s surgery made potential future surgeries more manageable. It also offered her an opportunity to see how a major surgery impacted her life logistically. Between the physical and familial challenges that come with major surgery and her confidence in current monitoring, she does not feel ready for mastectomies anytime soon. However, she take comfort in knowing that she is one step closer, should she eventually take the plunge.

“Recovering from the surgery I did as a mom—it takes a village. I’m on the run all the time. My husband works, and he helps out as much as he can, but I just can’t see myself being out of commission again. Right now I feel comfortable monitoring closely.”

Life as a high-risk patient—or previvor—can feel daunting. Celeste’s unusual decision highlights the powers of comprehensive information and creative thinking. Her story is a great example of how you can use the information you have to make decisions one step at a time. When you truly know and understand your options, they can give way to treatment paths that you may not have imagined prior.