A woman who underwent a preventative double mastectomy after inheriting the BRCA2 gene from her father has regained sensation in her breasts thanks to pioneering reconstruction surgery.
Serafina Nance, 26, an astrophysics PhD student from California, discovered she had an 87 per cent chance of developing breast cancer in her lifetime.
Rather than go through regular MRI scans and the agony of constantly waiting for test results, she decided to have a mastectomy.
While researching the surgery she said she was ‘shocked’ to discover women having the operation should expect to lose sensation in their breasts.
Serafina Nance, 26, an astrophysics PhD student from California, discovered she had an 87 per cent chance of developing breast cancer in her lifetime and decided to get a mastectomy
Serafina came across the work of San Francisco-based surgeon Dr Anne Peled, who is pioneering a new technique called nerve preservation, where painstaking care is taken to maintain sensation in the breasts.
Now, nearly five months on from her operation performed by Dr Peled, Serafina can feel ‘100 per cent’ of her right breast and three quarters of her left.
Speaking to BBC Radio 4’s Woman’s Hour, she explained: ‘On my right side, with nerve preservation, I honestly can feel 100 per cent of my breast.
‘The nipple part and the areola part are a bit numb still, but the rest of the breast feels totally normal.
Serafina came across the work of San Francisco-based surgeon Dr Anne Peled (pictured right), who is pioneering a new technique called nerve preservation, where painstaking care is taken to maintain sensation in the breasts
‘On my left side it’s about three quarters of the way there. The way nerves regenerate and heal, we expect for that sensation to continue to come back with time, typically over the timescale of about a year.’
Serafina’s father was diagnosed with prostate cancer when she was 23, and genetic testing revealed he carried the BRCA2 gene.
His oncologist suggested his daughter get checked, and it came back positive.
When she was 25, Serafina began getting routine screenings and MRIs – and after her first scan, they found something.
‘It was benign, but the stress of having to undergo those MRIs every six months and waiting for test results, waiting for this inevitable breast cancer, I decided basically shortly afterwards that it was time for me to move forward and go ahead and get a mastectomy,’ she told Woman’s Hour host Jenni Murray.
Dr Ayesha Khan, a breast surgeon at Chelsea and Westminster Hospital in London, who also appeared on Woman’s Hour this morning, explained that there are two distinct cohorts of women having mastectomies and reconstruction.
The first are those with an established cancer diagnosis, where it’s imperative the cancer is removed as well as a margin around it, and the second are people like Serafina, who don’t have a cancer diagnosis but have a very high risk of developing the disease.
When Serafina began researching what type of reconstruction she wanted and the process, she couldn’t believe that the inevitable loss of sensation is not more widely discussed and publicised.
She sought surgeons who are working towards addressing the issue and found Dr Peled.
‘She is a uniquely trained surgeon in that she does both the mastectomy aspect of the surgery and the reconstruction,’ Serafina explained.
‘Typically they’re two separate surgeons that perform both surgeries. Because she has a unique training, during the mastectomy’s portion she does something called nerve preservation.’
Dr Khan explained that when a surgeon is performing a mastectomy, they remove all the breast tissue. On top of the breast tissue is a layer of fat before the skin, throughout which the sensation nerves run.
It’s not always possible to leave that layer of fat completely intact while removing the tissue, especially if the patient has cancer.
When she was 25, Serafina began getting routine screenings and MRIs – and after her first scan, they found something. Rather than go through regular testing and scans, she decided to have a prophylactic double mascetomy. Pictured during her healing
‘When patients come to clinic they ask how their breasts are going to look, will they be symmetrical,’ Dr Khan said.
‘We talk about sensation loss, and a lot of women accept that as part of their cancer treatment. But five or ten years later when they go on to live beyond their cancer, it then occurs to them, “I’m back to a normal life, my reconstruction looks good, but my sensation is not coming back”.’
Serafina told how Dr Peled – also a breast cancer survivor – is highly conscious of preserving the nerves in the layer of fat to the extent that she can.
Dr Peled told the BBC: ‘When I had my own diagnosis… I had a really, really difficult time making a choice, because I felt like it was so daunting to consider at age 37, having no sensation in my chest for the rest of my life.’
If nerves are unable to be preserved, during the reconstruction surgery Dr Peled works with a nerve surgeon – coincidentally her husband – and they do nerve grafting, where they actually reconnect the nerves.
Now, nearly five months on from her operation performed by Dr Peled, Serafina can feel ‘100 per cent’ of her right breast and three quarters of her left – which is expected to improve within a year
‘For me personally, one side has nerve preservation and the other side has nerve grafting,’ Serafina said.
Asked how likely it is for a woman in the UK to have this type of surgery, Dr Khan the main step towards trying to preserve sensation has been a shift towards trying to do nipple sparing mastectomies.
‘That procedure alone seems to improve a woman’s sensation after surgery,’ she said.
‘We did a study at the Royal Marsden a few years ago looking at breast sensation and mastectomy after reconstruction, and this was without any form of nerve repair being performed, and we found that in up to 57 per cent of women, approximately three years down the line they had normal sensation in at least one quadrant of the breast.’
She added that Serafina’s nerve grafting implant reconstruction surgery is ‘very, very new’ and there’s currently only one published study reporting on it.