Beating breast cancer before it starts

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Delaware County native Marsha Bosch was living in fear of breast cancer. Not just because one in eight American women will get the disease, but also because almost all the women in her family had been diagnosed with it. 

“It wasn’t if I got breast cancer, it was when I would get breast cancer,” Bosch said. 

Her great aunts, aunts and mother all had breast cancer, even though each woman’s genetic counseling profile came back negative for the disease. When Bosch’s sister was diagnosed, she knew it was time to be proactive. She reached out to the professionals of Crozer-Keystone Health System.

Bosch consulted with Crozer-Keystone surgical oncologist Andrea Porpiglia, M.D. After reviewing her history, and even though she had no evidence of breast cancer, Bosch and Porpiglia decided that a “preventive” mastectomy was the best option. 

“Risk reduction surgery, such as bilateral prophylactic mastectomy, can be performed in women who have a high risk of developing breast cancer, (i.e., women with BRCA 1 or BRCA 2 mutations),” Porpiglia said. “It can reduce the risk of developing breast cancer in their lifetime by approximately 90 percent. It is a personal decision and should be discussed with breast cancer specialists.”

The mastectomy was a given, but Bosch had specific thoughts about reconstruction. Namely, she did not want traditional implants. So, Porpiglia laid out other options for breast reconstruction after mastectomy, and they chose DIEP flap reconstruction. During the procedure, a plastic and reconstructive surgeon uses fat cells, skin and blood vessels from other parts of the body (usually the abdomen or buttocks) to rebuild the breast.

On surgery day, Bosch’s medical team included Porpiglia, who performed the mastectomy, and Fox Chase Cancer Center plastic and reconstructive surgeon Sameer Patel, M.D., who is on staff at Crozer-Keystone and who did the DIEP flap reconstruction procedure. Both surgeries were performed on the same day, one following the other.

“[During] the procedure, I transplanted skin and fat from the abdomen to the breast area, leaving behind the muscle on the abdominal wall,” Patel explainedHe said the most intricate and time-consuming part of the surgery was reestablishing the blood supply from the old breast tissue to the new tissue. Patel notes that while, typically, DIEP flap reconstruction takes longer than other reconstructive options, it also eliminates implants – as well as any complications that can be associated with them.

Since the procedure, Bosch no longer lives in fear. She has gone from having a more than 50 percent chance of getting breast cancer to approximately one percent (because experts will never say anyone has a zero percent chance). She does not stress when she goes in for a mammogram about what it could reveal. In fact, she no longer needs mammograms. She just has to have a checkup with Porpiglia once a year to make sure nothing has changed.

Bosch is happy to have that stress lifted, but is also happy to have had Crozer-Keystone in her corner. She appreciated having options, and a specially trained medical team, to help her through one of the toughest decisions she has ever made. 

“It’s amazing for cancer patients to have these options,” Bosch said. “To have to go in for two surgeries on top of chemo and radiation would be unbearable. Having it all together is amazing. It was a great experience all around.”

”[Drs. Patel and Porpiglia] did an amazing job," Bosch said. "They were both so fantastic.” 

Bosch knew her body and her history, and educated herself on available options. That knowledge, along with the valuable input and skill from her Crozer-Keystone team, may have saved her life before it was ever in jeopardy.

If you’re looking for more information on breast health, or want to know more about how breast disease is diagnosed and treated, visit crozerkeystone.org/Breast-Health

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