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