The Angelina Jolie effect: what is behind it medically?

Since Angelina Jolie decided on prophylactic removal of the breast, this subject has been much discussed. The general perception of the subject of breast cancer has been a different one since then. That is also shown by a current exhibition of the ‘Venus von Wien’ at the Natural History Museum, which aims to create awareness and encourage reflection. But what options does a woman have if she wants to intervene early?Our expert Dr. Dobrovits explains:

It is important that it is first established whether a gene mutation (BRCA1 and BRCA2) is present. If that is the case, there are programmes for the early detection of breast cancer. Another option is to undertake a prophylactic mastectomy, that is to say a removal of the breast on both sides.

In the course of the removal of the breast, a simultaneous breast reconstruction can be undertaken. Here there are variants with the body's own tissue, with implants or a combination of both techniques, as with Angelina Jolie.
I myself have already carried out the reconstructive part successfully with many patients. With a genetic predisposition all these procedures are supported and also paid for by the health insurance funds.

Of course there are also special cases: patients who have no genetic predisposition but who develop cancer in one breast and express the wish to have both breasts removed. That is to say that they would also like the healthy breast – not demonstrably affected by the cancer – to be removed. As a rule this wish is complied with, but it requires a detailed explanation from the treating gynaecologist or general surgeon.
The reason for this lies, with these patients, in the risk of developing breast cancer again on the initially unaffected side, which is after all increased compared with the general population.

Even though one-sided breast cancer can be treated with breast preservation in more than 85 % of all patients, there are women who nevertheless want to have both breasts removed prophylactically.
I have also been involved in treating such patients and, after the removal of the breast by the treating gynaecologist or general surgeon, carried out the reconstruction in the same operation.

As far as removal of the breast without a genetic predisposition is concerned, from today's point of view this must be decidedly rejected! If there is no indication whatsoever of a familial, genetic predisposition and of course no diagnosed breast cancer either, then there is no indication whatsoever for such a procedure! That is quite comparable with a prophylactic removal of the prostate in men, which is not done either. As a rule the health insurance fund does not cover the costs of such a procedure either.

The most important thing, however, is that every woman affected must make this decision for herself!