Angelina Jolie's doctor has blogged the details of the actress's double mastectomy, and described how the actress "expected to feel well" throughout her three months of surgeries.
Dr Kristi Funk, of the Pink Lotus Breast Center in the US, wrote in detail about the main stages of the actress's treatment as part of the effort to increase awareness about BRCA gene mutations.
Jolie, an Oscar-winning actress, humanitarian activist and mother of six, announced yesterday that she underwent a preventive double mastectomy after learning she had an 87 per cent risk of developing breast cancer.
Jolie had the procedure after doctors told her she carried “a ‘faulty’ gene” that sharply increased her risk of developing both breast and ovarian cancer, which killed her mother at the age of 56.
Describing the steps that Jolie took, Dr Funk emphasised that the actress's decision is not the only option for a woman facing breast cancer. "Surgery will not necessarily be the right choice for everyone... as Angelina says in her article, the important thing is to be aware of your options," she wrote.
"To a large extent, I believe recovery reflects expectation," Dr Funk wrote. "Angelina expected to feel well, to be active... On day four after her mastectomies, I was pleased to find her not only in good spirits with bountiful energy, but with two walls in her house covered with freshly assembled storyboards for the next project she is directing. All the while she spoke, six drains dangled from her chest, three on each side, fastened to an elastic belt around her waist.
"The next day she had her first injection of saline into the expanders, thus beginning the process that would gradually prepare the tissues for the final stage of her operations, reconstruction. Four of the six drains were removed. Four days after that, on postoperative day nine, the last two drains were removed. A second saline fill occurred on March 4. Over the next four weeks she was hard at work.
"The final operation occurred on April 27, 2013, ten weeks after the mastectomies: reconstruction of the breasts with implant, which went extremely well, bringing an end to her surgical journey."
Brad Pitt, the actor and Jolie's partner, was on hand to greet her "as soon as she came around from the anaesthetic" for each operation, she said.
Family history usually triggers testing for the BRCA (Breast Cancer) gene, Dr Funk said, adding that a history such as Jolie's - whose mother and maternal grandmother both had ovarian cancer - "would certainly meet any insurance carrier's criteria to cover genetic testing".
In the blog, she provided links to more information on BRCA gene mutations and on genetic tests that women can take to help determine if they should be screened.
For those women who do carry the gene mutation, she described in detail the standard surveillance plan at Pink Lotus Breast Center that Jolie underwent.
Committing to an operation was the third stage of treatment, she said, writing: "When first meeting a woman newly diagnosed with a BRCA mutation, my immediate goal is to learn about her, including her family situation, whether she is in a stable relationship, and whether she is planning to have children. In the course of these discussions, it becomes clear whether the patient will proceed to a mastectomy."
Dr Funk also outlined the calendar regimen that the actress followed throughout the three months of operations, including the medications she had to take and the side effects of surgery and recovery that she endured.
The actress's surgeries concluded at the end of last month. She first underwent a painful procedure known as “nipple delay”, in an effort to save her nipples, before having major surgery to remove breast tissue in mid-February.
Nine weeks later, she received breast implants, and was informed that her risk of developing cancer had fallen to five per cent.
Last night Jon Voight, Jolie's father, said he was "as surprised as anyone" to have learned of her operation.
Voight, a veteran actor who was reconciled with his daughter in 2011 after a ten-year feud, said he had seen her just two days before she made the announcement.
“My love and admiration for my daughter can't be explained in words," Voight told the New York Daily News. "I saw her two days ago with my son Jamie. We all got together for his birthday, with her and Brad (Pitt). But I didn't know. It wasn't obvious at all. I found out (Tuesday) morning."
He added: “I was as surprised as anyone and deeply moved by the way she’s handled this. She’s a very extraordinary person, the way she examined it and what she shared.”
The actor said that he "absolutely" respected his daughter's decision not to tell him about the operations. "I completely understand," he said. "I want the focus to be on the inspiration."
He spoke to Jolie yesterday, after the announcement had been made, he said - but they did not discuss global reaction. "She just explained to me and educated me on this stuff," he said.
“The decision to have a mastectomy was not easy. But it is one I am very happy that I made,” Jolie, 37, wrote in an op-ed in the New York Times. “I can tell my children that they don’t need to fear they will lose me to breast cancer”.
Her mother, the actress Marcheline Bertrand, succumbed to ovarian cancer in January 2007. Mother and daughter were close, and Jolie has previously admitted that she struggled to cope with the loss.
“She held out long enough to meet the first of her grandchildren and to hold them in her arms,” said Jolie today. “But my other children will never have the chance to know her and experience how loving and gracious she was.
“We often speak of ‘Mommy’s mommy,’ and I find myself trying to explain the illness that took her away from us”.
On learning of the odds she faced, Jolie said that she “decided to be proactive and to minimize the risk as much I could”.
The actress, who kept a demanding international work schedule between her surgeries, said she had chosen to speak publicly about her ordeal “because I hope that other women can benefit from my experience”.
Her decision was hailed as "heroic" by her partner, the actor Brad Pitt.
Pitt, with whom she has three biological and three adopted children, said: “Having witnessed this decision firsthand, I find Angie’s choice, as well as so many others like her, absolutely heroic.
"I thank our medical team for their care and focus,” he told The Evening Standard. “All I want for is for her to have a long and healthy life, with myself and our children. This is a happy day for our family.”
Reassuring other women in her position that “I do not feel any less of a woman,” Jolie wrote today: “I feel empowered that I made a strong choice that in no way diminishes my femininity.”