Actress Angelina Jolie, 50, Who Says Her Preventive Mastectomy Scars Are Symbols of a Proactive Decision She Says Helps Ensure She’s Around for Her Kids

“I love my scars because of that,” she told People. “I’m grateful I had the opportunity to make a proactive choice about my health. I lost my mom when I was young, and I’m raising my children without a grandmother.”

For Jolie, the marks from surgery are not reminders of loss but of intention.

“I see my scars as a choice I made to stay here as long as I can with my children,” she said.

What to Consider When Weighing Preventive Mastectomy?

“Risk-reducing mastectomies are an operation where we take women at, usually, very high-risk for getting breast cancer, for genetic mutation carriers, who are the ones at the highest risk; there’s unfortunately only one way to actually prevent breast cancer,” Dr. Elisa Port, Chief of Breast Surgery at Mount Sinai Health System, tells SurvivorNet.

WATCH: What to Consider When Thinking About a Mastectomy

“Women who are found to test positive for a genetic mutation really have two options,” Dr. Port explains. “One is what’s called high-risk surveillance, which means we check them every six months or so, mammograms, MRIs, with the hope that if God forbid, they develop breast cancer, we pick it up early. But that’s not prevention; it’s early detection.

“Early detection is a goal; it’s not a guarantee. For the woman who wants to be more proactive about actually preventing breast cancer, or as we say, reducing her risk, unfortunately, the only way to do that is to remove the actual tissue at risk, and that is the breast tissue,” she adds.

Some women decide to have their breasts reconstructed and have implants put in right after the mastectomy, while others don’t have reconstruction at all.

The benefits of a prophylactic or preventative surgery are:

• Significant reduction in cancer risk (from 80-90% to 1-2%)
• Nipples can often be spared
• Women can get reconstruction at the same time

After a mastectomy, many women undergo breast reconstruction. Dr. Andrea Pusic, Chief of Plastic and Reconstructive Surgery at Brigham and Women’s Hospital, affirms the deeper significance of reconstruction: “Breast reconstruction is a restoration of a woman’s form and her sense of self.”

“Breast reconstruction is a restoration of a woman’s form and her sense of self. A lot of breast reconstruction is trying to erase the trauma of the mastectomy surgery, putting cancer behind a patient, saying this is in the rearview mirror, and putting her back on track,” Dr. Pusic told SurvivorNet.

WATCH: Breaking Down Breast Reconstruction Options

Plastic surgeons can reconstruct your breasts with implants or with your own tissue taken from some other place on your body, such as your back, your abdomen, or your inner thigh. Reconstruction that uses your own tissue is called a flap procedure. A flap can produce breasts that look and feel more natural than implants.

Like natural breasts, they can also change as your body changes. For example, they can get bigger or smaller as your weight changes. However, not all women are eligible for this surgery, such as those who smoke, have poorly controlled diabetes, circulation problems, or connective tissue disorders. Luckily, there’s another option.

Breast implant surgery is a significantly more straightforward process than a flap procedure; therefore, the recovery process is much quicker. However, implants won’t look and feel as much like natural breasts. As you age or gain or lose weight, the implants will stay the same, which could make them look less natural over time.

Implants can sometimes leak or burst. In this case, you would have to have them replaced. When choosing implants, women will then need to decide whether they want saline or silicone ones.

The main difference between the two is that saline is a sterile saltwater-filled implant and typically requires less monitoring since it’ll be pronounced if it starts leaking. While silicone implants usually feel better and look more realistic, they require more surveillance during an MRI. Additionally, if the silicone leaks, it doesn’t jeopardize your health, but it will need to be replaced immediately.

WATCH: Regaining your sense of self after reconstruction.

Reconstruct Now or Later?

Immediate reconstruction can produce better-looking results than delayed reconstruction, resulting in fewer surgeries overall. However, it may require a longer initial hospitalization and recovery time. This long surgery may also have a higher risk of complications, such as infections, than two separate surgeries.

It may be worth noting that “Delayed reconstruction has fewer complications than immediate reconstruction,” Dr. Terry Myckatyn, a plastic surgeon specializing in breast reconstruction, tells SurvivorNet.

The Jolie Effect

Angelina Jolie helped popularize BRCA genetic testing in 2013 after she penned an op-ed in The New York Times revealing she had the BRCA1 gene mutation. In her memorable piece, she noted the gene mutation increased her risk of breast cancer by an estimated 87% and her risk of ovarian cancer by 50%.

“Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much as I could,” Jolie writes. “I made a decision to have a preventive double mastectomy (removal of both breasts). I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex.”

“But I am writing about it now because I hope that other women can benefit from my experience. Cancer is still a word that strikes fear into people’s hearts, producing a deep sense of powerlessness. But today, it is possible to find out through a blood test whether you are highly susceptible to breast and ovarian cancer, and then take action.”

Jolie, who is a mother of six, had her ovaries and breasts removed after her mom, Marcheline Bertrand, passed away after battling breast and ovarian cancers.

Colloquially called the “Angelina Jolie Effect” or “Jolie gene” test, the impact of the actress’ op-ed prompted a notable spike in BRCA gene testing. The new test was created to determine the women who are at the most significant risk of developing breast cancer and ovarian cancer because of a specific gene mutation, the BRCA gene mutation. According to a 2016 Harvard Medical School report, “Researchers estimated that in the span of two weeks, the op-ed may have precipitated 4,500 more BRCA tests than would have normally occurred during that time period nationally at a price tag of $13.5 million.”

Understanding Genetic Testing

Genetic testing for cancer is usually done in a doctor’s office (either your primary care doctor or an OB-GYN), but a few tests are available for people to purchase commercially.

“It started out with a very narrow field of women and men who were recommended to have it based on certain risk factors, family history of breast cancer, or other cancers, and also ethnic backgrounds,” Dr. Port told SurvivorNet.

The National Comprehensive Cancer Network (NCCN) recommends testing only select patients with risk factors for hereditary breast cancer. These include, but are not limited to, patients who were younger than 45 years old when they were diagnosed with breast cancer, those with a strong family history of this cancer, and those with Ashkenazi Jewish heritage. The American Society of Breast Surgeons (ASBrS) recommends offering genetic testing for all patients diagnosed with breast cancer.

What If You Have the BRCA Gene Mutation?

If you discover that you do have a mutation, there are options available to manage your cancer risk, which include enhanced screenings; prophylactic (risk-reducing) surgery, which involves removing as much of the “at-risk” tissue as possible; and chemoprevention, the use of medicines to reduce the risk of cancer.

WATCH: Understanding the BRCA Gene Mutation

If you do discover you have ovarian cancer, it actually can be advantageous to have a BRCA mutation, as long as you are being treated with a PARP inhibitor, a drug therapy that was developed and approved by the FDA beginning in 2014. PARP inhibitors work by blocking the protein PARP from repairing the damaged DNA that can lead to cancer. These inhibitors kill the dangerous cells but leave the healthy ones intact, which is exactly what you want to happen.

“The PARP inhibitor prevents the repair of the (damaged) single-strand DNA break, and your BRCA mutation prevents the repair of the double-strand DNA break,” Dr. Rebecca Arend, Associate Scientist at the University of Alabama, Birmingham, explains to SurvivorNet.

Questions to Ask Your Doctor

If you’re facing the option of having a mastectomy, here are some questions to consider asking your doctor:

• What can I do to prepare for a double mastectomy?
• What happens before and after the procedure?
• For reconstruction, what are the benefits of using implants over my own tissue and vice versa?
• What should I know about implants? Should I opt for preventative surgery?
• What will recovery look like after the procedure?
• What are the benefits of a watch & wait approach vs. preventative surgery?
• What kind of surveillance is required after the surgery?

Learn more about SurvivorNet's rigorous medical review process.

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