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Dr. Kristi Funk

The founder of the Pink Lotus Breast Center made international headlines when her patient Angelina Jolie divulged that she’d had a double mastectomy

Since opening the Pink Lotus Breast Center in 2009, Dr. Kristi Funk has made frequent media appearances to stress the importance of women exercising, limiting alcohol intake, and watching their weight to maintain health. In May, however, the surgeon’s visibility went through the roof. That’s when her patient Angelina Jolie—actress, mother, philanthropist—revealed that she had undergone a double mastectomy after discovering she carried BRCA1, a genetic mutation that greatly increased her chances of developing breast and ovarian cancer. Jolie’s decision was controversial—while most people deemed it courageous, some saw it as an overreaction. Aside from a blog post detailing the procedure, Funk has spoken little about it publicly since the news broke. Los Angeles magazine editor-in-chief Mary Melton, herself a patient of Funk’s, sat down with the doctor at the Beverly Hills offices of Pink Lotus, which Funk runs with her husband, Andy. The L.A. native, who’s also the mother of four-year-old triplet boys, talked about faith, fear, and getting every woman the medical care she deserves.

How did you become a surgeon?
When I was in medical school at UC Davis, the first thing I did was surgery and everything else paled. I remember one day F. William Blaisdell, the chief of surgery there who was kind of famous, was in an elevator and the door was closing, and I ran over and kicked my foot out to make the door open. I walked in and said, “Hi, Dr. Blaisdell!” And even though I’d left my badge at home, he said, “Hi, Kristi.” And I thought, “He knows my name.” He said, “You know, only a surgeon would use their foot to stop the elevator.” And that was it. I did four years of med school there and five years of residency—general surgery at Virginia Mason Medical Center in Seattle. Then I came down to Cedars-Sinai because they had a laparoscopy fellowship and I was interested in minimally invasive surgery. When I got there, the head of that fellowship was also the director of the breast center, and he said, “Oh, by the way, you’re going to be the director of the breast center.” And I was like, “I like minimally invasive surgery. The esophagus and the stomach, these are my favorite organs.” They were!

What is so appealing about the stomach?
The way it handles a suture. It’s awesome.

So you weren’t so sure about being a breast doctor?
I had just spent years becoming a well-rounded and well-trained surgeon. I can take your lung out, I can put your heart on bypass, I can take out your colon, and I can do it well. And I’m going to be just a breast surgeon? Breast surgery isn’t hard. The decision making, the hand holding—that’s hard. But the surgery isn’t. That’s what I thought. I’ve made it hard, though, by striving for the smallest incisions. Not to challenge myself, but because it’s the cosmetically best outcome. Anyway, I did a breast fellowship for a year and then delved into breasts 100 percent. From that day forward I never did another colon.

Tell me about your upbringing.
I grew up in the Palisades, went to Marymount High School and then Stanford University. But growing up, I was a complete tomboy. I have one older sister who is 12½ years older, and three older brothers who are 11, 10, and 8 years older than me. I was a total mistake. I was the fourth boy forever.

So you were beat up a lot.
I’d be watching TV and there’d be this battle cry: “Commercial!” Then bean bag chairs would come flying over the couch, they’d smother me, sit on me, fart in my face. Yeah.

Battle wounds!
For seven years I was the only girl in a league of 300 boys playing hard ball in the park. Later, when I started at the Cedars breast center, I was the only female working with five men over 50. And being a woman made a difference. To this day, every patient I’m operating on, I try to make a breast that I can live with—as if that breast were mine.

Do you think the anxiety about breast cancer is more extreme than about other cancers?
Yes, because breast cancer is more common, though it’s not the most common cancer from which women die. If you have a problem, you immediately let your mind unravel to the worst-case scenario. But I do see a lot of benign disease. Our mission is to save lives in a way that eliminates fear, instills confidence, and provides hope in a moment of panic. That’s why at Pink Lotus we have a 24-hour pathology turnaround with biopsies. Because one more night of waiting is one more night that my patients are writing their wills.


This article was originally published in the September 2013 issue of Los Angeles magazine

The vast majority of breast cancer is curable. Why do women jump so quickly to worst-case scenarios? Most women I know, when they have a headache, don’t immediately think they have a brain tumor.
The stories about breast cancer that are most poignant, shocking, and newsworthy tend to end badly. So women’s minds go to the most recent thing they’ve heard, which maybe is Elizabeth Edwards. But she’s not the norm. Stage 0, 1, and 2 cancers are very curable, and Stage 3 is curable, too, but takes a lot more treatment because it can become Stage 4. Everything but 4 is curable. People leap to the worst-case scenarios because they don’t realize that Stage 4 is not the most common. When women present with breast cancer, only 5 percent will be Stage 4; 61 percent will be early stage; 32 percent will be in the middle. The vast majority? I get to walk in the room and say, “I’ve got good news.”

The breast is just so, forgive the description, weighted a body part for women and their self-image.
It’s undeniably connected to femininity and sexuality and body image and womanhood. It takes a strong sense of self, which we hope women strive to achieve, to say, “I am not my breasts,” because breasts are symbolic. If you want to say otherwise, you’re in denial. Also, it is much more devastating to have something external altered unwillingly. People don’t say, “Can you just take a little less of my colon? How much of my colon are you taking? What will it look like?” You don’t have those conversations about colons. I have them all day long about breasts. And I love those conversations. What is the biggest fear when a woman walks in who knows she already has breast cancer? Chemo. What is the fear with chemo? Hair loss. Because it’s external. They can’t hide it. It’s a daily reminder, before they get their wig on and their happy face going, that these are rough days. It’s an unavoidable statement, at least to yourself, that something has gone—I won’t say wrong . . .

Different?
Different than planned or than what you had hoped for. But so many men and women emerge stronger from this disease. It can alter their sense of self or even their career path or their relationships for the better. For many it took something as loud as cancer for them to listen. Many women will say, “I don’t regret having gone through that. I’m better having walked through the fire.” They surprise themselves with their resilience. It’s almost like they fall in love with themselves for having endured something so threatening and then emerged victorious from it. That’s what makes me pop out of bed and run into work. It’s just so fun.

Where does your optimism come from?
I was born into an extremely loving family, and I have an unshakable Christian faith. And I’m a blend of my mom’s and dad’s positive attributes. My dad is incredibly kind, can’t think ill of anyone. He’s a stock market analyst, but he grew up poor in Connecticut, as did my mom. As a boy, he’d wake up at 4 a.m. to pick tobacco before school. He treats everyone like family. My mom, who was a dental hygienist, has an inner strength, a determination, and a demand for perfection. When she was 37 and I was one—she had five kids under 13—she had a massive stroke. She was in rehab for three or four years. She couldn’t speak and she didn’t come home. And when she did, she was paralyzed on her right side. But by the time I was five or so, she had perfect speech, she was out of her wheelchair, she walked without a cane. Her right arm didn’t always work and was a little atrophied, but my dad jury-rigged the car with a knob on the steering wheel so she could drive me everywhere I needed to be. She was an amazing mom—she was at every athletic event, every play I ever did. My mom never gives up hope, she never stops fighting. She pushes her body and her mind to that extra limit. She’s 79 now, is back to holding her cane. But at her peak, a long peak of 30 years, she had completely conquered this. So between my father’s quiet, observant, caring compassion and my mom’s vivid determination to be the best, I somehow blended into this person who is determined to make every moment matter. Really, what is life but a long series of moments? So the more moments that are powerful or joyful, the more impactful and wonderful your life.

That’s a beautiful way to say it. The optimistic side of me agrees, but at the same time I worry that those moments can be taken away. I’ve had big losses in my family. You are dealing with that every day: people who are facing the fragility of their own lives. When did you realize you had the capacity to tell people hard news?
When I was in medical school, the first thing I did was trauma. That’s why I’m a surgeon. I loved the immediacy of, Here’s a problem, I can fix it. But I remember when I learned not to make promises you can’t keep. I may cry when I talk about it. There was this old man who came into the ER, and his aorta had burst so he was bleeding out. I was running by the bed as it was being pushed down the hall, doing the intake, and I’m like, “Are you on any medications? Do you have any allergies?” He’s just a stranger, and I’m trying to figure out stuff as we’re racing into the OR and he’s losing consciousness, and he stops and he just says, “Tell my wife I love her.” And I was like, “Um, no, you’re going to tell her when you wake up.” And then he died on the table.


This article was originally published in the September 2013 issue of Los Angeles magazine
Did you tell her?

Yes. He’d said what he wanted to say, and he knew I heard him because I answered him. But that was hard news to give to her. He was the first person who died like that for me. Trauma is hard. You think, “I can save them! I can save them! ” Then no, you can’t. You go from super adrenaline to a crash.

You opened Pink Lotus Breast Center—a private health clinic focused entirely on breast-related illness—in March 2009. Do you think entrepreneurial medicine like this is the way of the future?
I think the future has a clear divide: You’re going to have hospitals, whether university affiliated or community based, and then you’re going to have specialty centers. And these centers will focus on diseases that don’t require hospitalization for the majority of situations and that humanize and personalize the medicine delivered. Hospitals can be too big, too many patients. People who work there are not necessarily committed to a cause. The job is to check you in. Here the job is to check you in, make you smile, get you coffee, welcome you to my home.

What have you seen in terms of medical advancements since you opened the center?
I remember when I first started at Cedars 11 years ago, I was surprised by how the majority of physicians had no idea their patients were eligible for BRCA testing. The whole idea of this mutation was largely misunderstood but always obvious to me. So there is now an awareness of genetic predisposition to cancer beyond BRCA and risk assessment. There are factors that include the density of your breast tissue and your lifestyle choices, and we’re starting to have a better sense of how the collision of these factors can be used to guide those choices. The biggest transition here at Pink Lotus is that lately the conversations have turned a lot more toward mastectomy.

Since Angelina Jolie made her announcement about getting a double mastectomy, how much more are you hearing about BRCA?
The question seems to echo through the halls wherever I go. And I love it because—guess what—the answer a lot of the time is “No, you’re off the hook, there’s no indication you have BRCA.” One in every 500 to 800 women carry BRCA, and it’s enough to analyze everyone who walks through this door. It’s covered by insurance, so it’s a no-brainer. Why shouldn’t everyone who can empower themselves with this information? Still, we’d be right on target if 90 percent of women we test are negative. Moreover, only 5 to 10 percent of all breast cancer patients have a genetic mutation we can test for, and not all of that category is BRCA.

How helpful has it been to have a famous face attached to BRCA?
If your goal is to reach women around the world and back again, and to create awareness and education, then it’s incredibly important. It’s indispensable because it’s simply easier for people to listen to someone whom they adore and trust, and that’s who celebrities are. Celebrities come into your home via TV and movies and magazines. While they have no idea who you are, they are somehow friends of yours. So it was your friend Angelina who expanded your understanding of what breast cancer is or could be. You had no idea until she said it that there was a gene out there that could be tested through your blood or saliva.

I consider her a citizen of the world.
Her humanitarianism and philanthropy are unparalleled in the celebrity world. Not to mention that she’s just extraordinarily beautiful. So when someone who inspires that degree of admiration—someone who’s taken seriously and is also a tremendous beauty, arguably the most beautiful woman in the world—removes the part of her body that, as we’ve discussed, is symbolic of femininity and sexuality, you have to say, “Why would she do that?” And when you hear the answer, if you are a woman or if you love any woman, you have to ask, “Should you find out about that?” You’ve just educated over a billion people. It gave me a platform from which I could reach millions of women who might otherwise not hear the advice I have to give and potentially save their lives.

Was it clear from the get-go that Angelina, as your patient, would make her experience public?
Yes. She waited to find the perfect timing in her personal and professional life, but I think most importantly in her soul. She is intensely private, but she calculated the moment when she would be ready to reveal something so personal. She knew always that in her philanthropic core she couldn’t keep this a secret and be who she is. She always knew.


This article was originally published in the September 2013 issue of Los Angeles magazine

It must have been intimidating for you. Not just because you were performing surgery on someone so famous (and whose body, because she’s an actress, is such a part of her identity), but also because you knew the results would be so publicly scrutinized. How did that affect you?
Treating Angelina forced my mind into a creative mode. I thought through every possible thing that I could do to improve outcomes and developed some beautiful, helpful changes to both the surgery and the preparation. For example, I did think of doing something called prophylactic breast dye injection, which uses blue dye to chart where cancer may have spread through the lymphatic system. When you take off a breast prophylactically, there’s a 2 to 8 percent chance you’re going to find a surprise cancer you didn’t know was there. But the breast has already been removed, so you can’t inject the dye to chart its spread. So I came up with the logical idea that had not previously been done: inject the dye at the time of mastectomy, and if sentinel nodes turn blue, mark their location. If there is no cancer, no unnecessary procedure was done to find that out; if there is cancer, I can find the one or two nodes and remove them. I don’t publish papers—I know myself well enough to know I have no interest in being a researcher. But Angelina insisted I write this method up. She was very cute. I told her I don’t like writing. But because of her constant insistence I wrote it up in a blog.

You mentioned that most insured people are covered for genetic testing. What about women who aren’t covered or lack insurance altogether?
We’re starting a nonprofit for the uninsured called Pink Lotus Petals. When we get our 501(c)(3) status, this will be a game changer for the underprivileged women of L.A., certainly, but also hopefully the country and the world. This is our truest mission—the footprint my husband, Andy, and I will leave. It will provide services and genetic counseling to people who can’t afford them now.

You put a lot of value in lifestyle changes as well.
Something pretty unique to Pink Lotus and our philosophy as surgeons is dispensing lifestyle advice. I hope and think it can be more impactful coming from a physician than from your mom: “You know what, honey? You need to lose ten pounds.” The two most modifiable risk factors for breast cancer that are undeniable across all populations are obesity and alcohol. So if people will lose weight and drink less, and have a diet that’s high fiber, low fat, and lean meats, they reduce their risk.

What does alcohol do?
It inactivates folic acid, which is necessary to repair DNA when it goes awry. A tidbit to the drinkers: I take 600 micrograms of folic acid as a supplement every day. It completely counteracts the effect of alcohol. The other thing alcohol does is increase estrogen levels; 75 percent of all breast cancers are fueled by estrogen.

So there are things you can do to lower your risk of getting breast cancer. I imagine there are still a lot of women who don’t realize that.
They don’t, and if they did, it would likely mean having to institute changes, and changes are difficult. It’s the same reason some women don’t get mammograms. Many of them don’t because you don’t have to deal with what you don’t know.

Are there days when you find yourself missing the stomach and the esophagus?
Only when I eat too much do I think about the stomach now. I’m just glad that I could follow the path that was set before me, and I’m so grateful for what I have. Between love of family and my strong belief that I have purpose, I wake up and make every moment matter. Whether it’s tucking the kids in bed at night (and answering the question “Why do I have to go to sleep now?”) or telling a woman she has breast cancer (and answering the question “Why me and what do we do?”), I’m fully committed.       

 


This article was originally published in the September 2013 issue of Los Angeles magazine