Breast cancer survivor grateful for personalized mastectomy and reconstruction decisions

Frances Arnoult had a double mastectomy, but she never had to see what she would have looked like without breasts. That’s because her MD Anderson breast surgeon and plastic surgeon teamed up to perform both surgeries at once in April 2018.  

“Once it was done, it was done,” Frances says. “And, for me, that was a real gift.”

Patients undergoing breast cancer surgery face a series of extremely personal decisions. But Frances says her MD Anderson care team empowered her to make the best ones for her from start to finish of her breast cancer treatment.

A pre-invasive breast cancer diagnosis MD Anderson for breast cancer treatment

Frances was devastated when her doctor told her of her breast cancer diagnosis. She had ductal carcinoma in situ (DCIS), a pre-invasive breast cancer that can sometimes become invasive and spread out of the ducts into nearby tissue. It was in her left breast. Frances had an appointment that had been scheduled for her at another Houston hospital, but her plans changed when she turned to a friend and breast cancer survivor for comfort.

“You live less than 7 miles from the best cancer hospital in the country,” her friend said. “Why would you go anywhere else?”

Frances reached out to MD Anderson the next day.

Mastectomy and breast reconstruction decisions

At MD Anderson, Frances underwent mammograms of both breasts and an ultrasound-guided biopsy which confirmed her DCIS diagnosis. After that, she  saw breast surgeon Isabelle Bedrosian, M.D., and plastic surgeon Carrie Chu, M.D. Frances’ care team recommended a mastectomy on her left breast, where the cancer was located. The biopsy showed that it hadn’t spread, but the mass was large. Frances did not necessarily need to have the other breast removed, but she decided a double mastectomy would give her peace of mind and she liked that, aesthetically, both breasts would look similar and age similarly over the long term as well.  

Once she made that choice, Frances needed to determine if she wanted to have breast reconstruction using implants or her own tissue. Dr. Chu showed her how they would remove the extra tissue from her abdomen to create her new breasts.

“I liked the fact that it would be all me,” Frances says.

Dr. Chu explained the pros and cons associated with this type of surgery. She would use a technique called microsurgery that relies on a magnifying glass and robotic tools to remove and reattach the tissue. Consequently, this takes longer than the average surgery, and with a longer surgery comes increased risk of complications and side effects, like pressure wounds. The recovery also would take longer. Frances would have to wait for both her chest and abdomen to heal.

Frances liked knowing that her new breasts would be made from her own tissue. She would have to undergo a second surgery for nipple reconstruction and fat grafting for shaping a few months later. (A nipple-sparing mastectomy wasn’t an option because of where her cancer was located.) But if she had had breast implants, she would need additional surgery years down the road to replace the implants.  

“Making these decisions became easier because I trusted and really liked my care team,” says Frances, adding that her medical team made her feel at home. After a consultation she turned to her husband and said, “You know, we were laughing in there!” She couldn’t believe that she could find fun in something so serious and scary.

Breast reconstruction recovery

On April 14, 2017, Frances underwent a double mastectomy and breast reconstruction, including what plastic surgeons refer to as a DIEP flap. She stayed in the hospital for the five days following the surgery. Every hour, Dr. Chu or another member of her care team would check to see how the relocated tissues were adapting. Though she had significant pain the first few days after surgery, it was manageable with medication. By day three, she was able to walk the hospital halls with the help of a walker.

Each day, she felt a little better and gained a little more strength. Twelve days following surgery, Frances started physical therapy at MD Anderson twice a week for six weeks, then once a week for another six weeks. The physical therapy helped improve her range of motion, posture and built strength.  After three months, she was able to return to her Pilates class.

“Planks are still a little more challenging than they used to be,” she says, but otherwise, she is back to her old self.

Frances looks back on her experience with gratitude, knowing she made the right decisions for her and her specific cancer case.

“Everybody has a story,” Frances says. “And every story is a little different. I know I did what was right for me.”

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