Steamboat woman undergoes double mastectomy and immediate reconstruction
June 16, 2013
Steamboat Springs — When Peggy Wolfe booked a surgical team for a double mastectomy and immediate breast reconstruction in March, she also sent out invitations for a cocktail party.
Wolfe, 55, a well-known Steamboat Springs Realtor, had more than one motive for serving wine and appetizers to her friends five days before her surgery. Because she is on her own, she knew she would need emotional support in the aftermath of the surgery. But Wolfe also wanted to lend strength to other women.
Recommended Stories For You
"I did it because I wanted to let women know that when you are diagnosed, it is something you can live with — you do have options, you can be OK," Wolfe said. "But there is also a reason I did it for myself. I knew those friends would be there for me, but it meant so much to me when I had like 30 women show up at my house."
Not only was it important to Wolfe to hear from those friends that she could call them if there was anything she needed, it was important to her that each of them realize they would not be without a support team of their own if they found themselves in a similar situation.
Wolfe already had been contemplating creating a blog about her experiences with breast cancer and the research she pursued before making potentially life-changing decisions, when film actor Angelina Jolie went public with her own double mastectomy. The news coverage galvanized her thoughts and helped her turn intent into action. Wolfe decided to go public with her experiences because she wanted to make sure other women would be less fearful and not hesitate to get annual mammographies and take the next steps, if necessary.
It's a family affair
Peggy Wolfe was the youngest of three sisters who were born and raised in the river town of Marietta, Ohio. Her maternal grandmother, Marie Davis, died of breast cancer at 45, when her own mother was pregnant with her first child. Peggy never knew her grandmother, but she has a sense of the effect her grandmother's death had on her mother, Betty Wolfe.
"I know that had a big impact on my mom," she said. "With a woman's first child, they look to their mother to learn how to take care of a baby."
Years later, two of Marie Davis' sisters were also diagnosed with breast cancer. Both of them survived.
"I was still probably 7 to 8 years old when I first heard the word 'breast cancer'," Wolfe recalled. "I knew (her great aunts) had surgery, but I wasn't aware of everything."
Breast cancer skipped a generation in Wolfe's family – neither her mother nor her two sisters had the cancer. It was a possible sign that her generation was not genetically pre-disposed to the disease.
"I think my mother was always fearful that she would get breast cancer or one of us would," Wolfe said. "She impressed upon all of us, 'You must have an annual mammography.' That was just one of those things — it was just a given. I and my sisters have always had one."
Jolie announced in an op-ed article in the New York Times in May that she had opted to undergo a preventive double mastectomy after learning that she carried a mutation of a specific gene, BRCA1, that increased her risk of developing breast and ovarian cancers. She wrote that doctors told her she had an 87 percent risk of breast cancer, and that she decided to follow a proactive path toward avoiding the disease by having her breasts removed and reconstructed before even being diagnosed.
When Wolfe was first diagnosed after doctors found a cancerous lesion on just one breast, it did not necessarily suggest a genetic predisposition.
"Two different cancer surgeons said, 'Your family history didn't have anything to do with this,'" Wolfe recalled.
She had been traveling to Rose Medical Center in Denver for her mammographies for eight years. This year they asked her to come back for an ultrasound, because that technique reveals more than a mammography. The ultrasound confirmed the lesion in her right breast, and a needle biopsy confirmed it was cancerous.
At that point, doctors said they wanted to do an MRI, and that procedure detected the lesion in her left breast.
Wolfe was sitting in a surgeon's waiting room, seeking a third opinion, when she received the results of the second needle biopsy.
"When I went into the third surgeon's office and said, 'I've been diagnosed in both breasts,' the first thing she said was, 'Now we don't have to bother with a conversation about whether to do a lumpectomy or double mastectomy,'" Wolfe said.
Curiously, Wolfe said, the lesions in both breasts were caught very early, but post-surgery, when she and the surgeon had a chance to go over the pathology, she learned that the lesion in the second breast that was not detected by mammography was actually larger than the first.
Immediate breast reconstruction
Before coming to Steamboat Springs to launch her career in real estate, Wolfe had pursued another sales career representing orthopedic devices used in implant surgery. In that role she had an opportunity to sit in on hundreds of surgical procedures.
The knowledge gleaned from that prior career taught her to do a great deal of research into her own health issues and the options available for treatment.
"It helped me when I went on the Internet to research doctors and techniques," she said. "I tell people to do their own research and to feel free to look beyond Steamboat and find what's best for you. When it comes to health care, you have to be your own advocate."
Wolfe learned that the women's Health Care and Cancer Rights Act of 1998 includes a provision that women covered by group health plans, insurance companies and HMOs are entitled to coverage for reconstructive surgery, if they choose.
An informational page at the U.S. Department of Labor confirms that fact and adds: "Coverage includes reconstruction of the breast on which the mastectomy was performed, surgery and reconstruction of the other breast to produce a symmetrical appearance, and prostheses and treatment of physical complications at all stages of the mastectomy, including lymph edemas."
Wolfe also recommends the nonprofit CoverColorado, which was created by the state Legislature to extend health care coverage to people who have been denied because of a pre-existing condition. She expects to rely upon CoverColorado in the future when her COBRA coverage expires.
Still, Wolfe knows some women will hesitate to aggressively seek mammograms.
"I have tried to contemplate why women don't have an annual mammography," Wolfe said. "One of the thoughts I considered is, women say, 'I don't want to know' out of fear for the disfiguring surgery that was the norm for decades."
Wolfe observed that society supports and promotes physical beauty, and it's likely Jolie's status as an icon made her decisions to share her story publicly so powerful.
"If this is a reason that some women choose to not have an annual mammography, then I want to do what I can to let women know that as long as your cancer is detected early, then you have the greatest number of options in terms of how you deal with it."
Through her research, Wolfe also learned that reconstructive surgery has better outcomes when a plastic surgeon for the reconstruction is chosen in advance of the mastectomy. That way, the plastic surgeon can communicate to the other surgeon what procedures will give them what they need to do their best work.
The plastic surgeon she chose is using a new technique unknown to a number of physicians. It's based on a new product — a mesh that a woman's skin tissue grows into (it's not the mesh used in other types of surgery that has led to lawsuits). What the mesh allows, Wolfe said, is for for a doctor to place the breast implant outside the msucle wall and then place the mesh around it.
In the past, Wolfe said, surgeons inserted a ballon inside a woman's chest muscles and added water or saline solution every week or 10 days, stretching the chest wall until it was expanded enough to permit another surgery to remove the balloon and place a permanent implant.
The new technique meant that Wolfe only had to undergo one surgery and one recovery. And it meant she didn't have to go the the complex emotions of missing her breast for six to eight weeks following the double mastectomy.
"Emotional and physical recovery are all one. It's all you, it's all one person and it's all one person that is healing."
Another step Wolfe took to protect her own sisters was to undergo the costly genetic test that Jolie took to find out if their family carried the gene mutation that greatly increases the chances of having breast or ovarian cancer.
"My cancer surgeon said, 'It's expensive (about $3,000), but I highly recommend it.' I happen to be on a COBRA (insurance) policy that is BlueCross/Blue Shield. They've been great about paying it."
Wolfe wants people to know that the cutting edge medical procedures aren't just for celebrities – they are for every woman.
"You don't have to be a Hollywood actress to deal with this and take care of yourself," she said. "You can be an everyday person."
To reach Tom Ross, call 970-871-4205 or email tross@SteamboatToday.com