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This Woman Got a Double Mastectomy in December—and Ran Her First Marathon in November

Runner’s World logo Runner’s World 9/12/2018 Cindy Kuzma

a woman taking a bite out of it: A breast cancer diagnosis may have you wondering if you'll ever be able to run again. Here's what you need to know about running after a mastectomy. © Courtesy of Racing Against BRCA A breast cancer diagnosis may have you wondering if you'll ever be able to run again. Here's what you need to know about running after a mastectomy. Caroline Plank hadn’t even hit 30 when she found a lump in her breast in 2016. Her oncologist said the cells were precancerous, and offered Plank a choice: a lumpectomy to excise them, or mastectomy to remove her whole breast. If she chose the latter, she could have a reconstruction to rebuild it, too.

While Plank was young to be dealing with breast cancer fears, the news didn’t exactly come as a surprise. In 2011, at age 22, Plank tested positive for a mutation of the BRCA2 gene that significantly increases her chances of developing cancer. Plank had watched her mother and several other relatives undergo treatment; an uncle had just died of breast cancer.

“It was kind of like, okay, I was planning to do this anyway, so let’s just do it now,” Plank told Runner’s World by phone. The timing made sense in more ways than one, she thought: “I want to run the New York City Marathon, and this will give me enough time to get better, if I do it in December.”

a person sitting on a bed: Caroline Plank in the hospital for her surgery. © Courtesy of Caroline Plank Instagram @bad_lemons Caroline Plank in the hospital for her surgery. As genetic testing offers women glimpses into crystal balls of cancerous futures, a growing number opt for preventive surgery. Rates of double mastectomies in women not diagnosed with breast cancer more than doubled between 2005 and 2013, from 2.1 to 4.4 per 100,000 women, data from the Agency for Healthcare Research and Quality shows.

According to the National Cancer Institute, these surgeries reduce the risk of developing breast cancer by up to 95 percent in women with harmful genetic mutations, and up to 90 percent in women with a strong family history of the disease.

The disease burden it can reduce is significant. But even without adding cancer treatments like chemotherapy or radiation to the mix, mastectomy and reconstruction are major surgeries, and require substantial recovery. For runners used to lacing up daily, that can be difficult to swallow-as can the fear that they won’t be able to train at their pre-op levels.

Recovery moves more swiftly for some women than others. Still, with time and patience, most will find they can resume their previous level of training and racing, says Mary Gemignani, M.D., a runner and a breast surgeon at Memorial Sloan Kettering Cancer Center in New York. Here’s what you need to know about running after a mastectomy.

How Running Influences Breast Surgery

First off, mastectomies and reconstructions are major surgeries that require time off from physical activity. And side effects like fatigue, pain, loss of fitness, and limited range of motion can make running slow going when you do start back, usually about six to eight weeks later.

Runner Caitlin Wilterdink, 34, of New York, tested positive for a disease-causing BRCA2 mutation in 2016. She’d been running for more than five years and had completed several marathons, including Boston. Still, she didn’t feel like doctors grasped her dedication to the sport and what it would mean to set it aside, even temporarily.

a group of people standing in front of a crowd: Caitlin Wilterdink had already completed several marathons when she tested positive for the BRCA2 mutation. © Zach Hetrick Caitlin Wilterdink had already completed several marathons when she tested positive for the BRCA2 mutation. One plastic surgeon, for instance, couldn’t comprehend why she wouldn’t want larger breasts after reconstruction. “I put the surgery off for a year; I just didn’t really want to think about it,” she says. The next year-after two rounds of biopsies and treatment for precancerous growths-Wilterdink changed her mind about the operation. She found a supportive surgical team (her new plastic surgeon ordered about 15 different sizes of implants, so Wilterdink could have the smallest ones that looked natural) and scheduled her mastectomy and reconstruction operation for December 11, 2017.

Some women who have preventive mastectomies, including some who are athletic, choose not to have reconstructive surgery at all, says Monet Bowling, M.D., a breast surgeon at Hendricks Regional Health in Danville, Indiana, and a runner herself. For those who do, the type-and timing-matters for their recovery and function.

Runners who want to take as little time off as possible usually opt to have an immediate reconstruction rather than two separate procedures, says Karen Horton, M.D., a plastic surgeon in San Francisco who frequently performs them, and also runs half marathons.

They also might prefer saline or silicone implants instead of what’s called autologous reconstruction, where surgeons use skin, fat, and blood vessels from women’s own abdomens or backs. Due to the additional incisions and repositioning of tissue, recovery from those procedures takes longer and comes with more restrictions on movement, Dr. Gemignani says.

Depending on the size of their breasts and how much tissue they have removed, some women can receive their final implants right away (Plank was among them).

Others, like Lindsey Hein, a 35-year-old Indianapolis runner and host of the podcast “I’ll Have Another” who underwent a prophylactic double mastectomy in 2013, opt for devices called tissue expanders to be placed in their chest when they undergo their procedures. Every few weeks, they’re filled with saline, then swapped out for permanent implants once their skin has stretched enough to accommodate them.

Surgeons can place implants either over or under pectoral muscles. Runners might choose over, so the muscle isn’t cut and then doesn’t squeeze the implants after healing, Dr. Horton says.

Hein had her initial mastectomy in October of 2013 and surgery to swap her expanders for implants the following January. She was able to run a little bit during the time in between, but it was awkward, she says-“they’re very hard; your chest feels like rocks.” She took six weeks off after each procedure, and was able to run the Boston Marathon that same April.

Side Effects of Mastectomies and Reconstructions for Runners

In many ways, runners have pre-op advantages. “It’s almost like you’re in training for surgery,” Dr. Horton says. Those natural endorphins may pay off: Wilterdink, for instance, was able to stop taking prescription painkillers within a few days after surgery.

But even with superior fitness and implants placed over the muscle, surgeons are cutting away tissue, creating scarring, temporary pain, and fatigue as your body heals. And though runners don’t use their upper body muscles as much as athletes like tennis players, you’ll still feel discomfort there when you start working out.

“I don’t think people ever realize how much you use your chest muscles in daily living,” Dr. Bowling says. “You use them to get out of a chair, to turn your waist, to breathe. That’s such a huge part of running, is being able to breathe freely.”

When Plank began running again, after eight weeks, breathing definitely proved difficult. In her first race back-the New York Road Runners Retro 5-miler last June-she felt intense pressure in her chest, as if her incisions might rip. She dropped out, and took an ambulance to the medical tent.

Fortunately, she’d done no long-term damage. Eventually, she learned to relax her diaphragm, and traded longer sports bra tops for shorter ones that didn’t squeeze her rib cage. Wilterdink struggled to find the right sports bra, too-at first, one with compression for her swelling and a front closure to accommodate her limited range of motion, then a high-support model in a smaller size.

While some of the physical effects of surgery diminish significantly in the first couple of months-Dr. Bowling tells patients they can expect to feel 85 percent better after six to eight weeks-others linger. Eight months later, Wilterdink still has sharp pains in her armpits and chest. They strike out of nowhere, and unlike the pain of pushing hard in a race, she can’t seem to push through them.

Though disconcerting, these sensations are typical. As nerves regenerate, you may feel numbness-which Plank describes as “like having a paperweight with plastic wrap around it on your chest”-then pins and needles, and finally distorted sensations called dysesthesias.

“The nerves are firing off independently without any stimulation and the brain is interpreting it as something that’s real,” Dr. Horton says. Eventually, they’ll dissipate; compression bras may help in the meantime.

Still, she encourages women who experience sensations that seem abnormal after surgery to consult their doctors. New lumps, nipple discharge, or a hardness around the implant-potential signs of infection and scar tissue, or in rare cases, of cancer-might warrant a follow-up.

Another long-term consequence: Since they lack blood flow, implants often stay only slightly warmer than room temperature, Dr. Horton says. Wilterdink has noticed this: “Not that someone would do this, but if someone decided to put their hand on my boobs after I came in from a cold run, they would be ice cold,” she says. “It’s funny.”

Mental Effects of Mastectomies and Reconstructions for Runners

Not all the impacts of surgery are purely physical. After her December operation, Wilterdink started running again in February, her sights set on the Paris Marathon in April, Berlin in September, and Chicago in October. “I was really trying to hit those goals-and ended up stress fracturing both legs,” she says.

Surgery didn’t cause her injuries, but the diagnosis brought Wilterdink face to face with some deeper issues. “It was a double whammy for me because I really have no control over my genes,” she says. “I consider running to be my source of strength, and something that almost negates the fact that my body has this thing that I can’t control. Having that taken away from me was the tipping point that forced me to really consider the mental impact.”

Even without the added insult of injury, women should expect emotional effects, Dr. Horton says. Reconstruction or not, mastectomy represents a loss. Nearly everyone hits a low, and women with a history of anxiety or depression experience flare-ups.

a man that is standing in the grass: Hein had her initial mastectomy in October of 2013, and is planning to run Boston again next year-then target a new PR. © Glenn Hein Hein had her initial mastectomy in October of 2013, and is planning to run Boston again next year-then target a new PR. And recovering from surgery strips athletes of a major coping mechanism. “We’ve taken away the one thing that’s your sanity saver, your church, whatever you want to call it,” she says. “It’s really common to feel anxious, depressed, out of sorts, and angry.”

In addition to treatment for the stress fractures, Wilterdink sought psychological support from a professional. In May, she began running again. She still plans to run Berlin and Chicago-with hopes of running a personal-best time in October.

Making New Running Goals After Breast Surgery

Though the five-mile race she couldn’t finish was disappointing, Plank also remained dedicated to her marathon goals after surgery. She hired a coach, added more protein to her vegan diet, and focused on strength work as well as ample rest and recovery days. But six weeks before the race, her immune system still compromised by surgery, she developed pneumonia.

Still, she made it to the starting line, wearing a singlet that said “Mastectomy 12/16; Marathon 11/17.” And she finished her first 26.2-in a Boston-qualifying 3:31:14.

Caroline Plank finished her first marathon-in a Boston-qualifying 3:31:14 © Courtesy of Caroline Plank Caroline Plank finished her first marathon-in a Boston-qualifying 3:31:14 “I wanted to show women that you can freaking do this, you have this surgery and you can get back out there and you don’t have to be afraid,” she says. She and her filmmaker fiance produced a short documentary about her journey, “Racing Against BRCA,” available on her website.

Another reason to resume your running habit: Even if you don’t qualify for Boston or run a full marathon, physical activity is one of the best ways to reduce your cancer risk, Dr. Bowling says. “I tell all of my patients that three days a week, 20 minutes of exercise can decrease your chances of having breast cancer by 10 to 20 percent,” she says. In fact, that’s what drew her into the sport.

And it was Ironman training, Hein says, that gave her the courage to find out about her genetic risk in the first place. Her mother had breast cancer and her grandmother had ovarian cancer; she knew her chances were high, but anxiety prevented her from getting tested. “I was alone in my head a lot in the pool, swimming and doing all these things that I’d never done before, and I would get all this courage to make a doctor's appointment and find out,” she says.

Though the surgery wasn’t easy, putting it in the past is a finish line she’s grateful to have crossed. Since then, she’s had three more children, and run several more marathons, including a personal-best 3:11:52 in the Indianapolis Monumental Marathon last fall. While she’s currently on another six-week break for the birth of her fourth son earlier in August, Hein is planning to run Boston again next year, then target a new PR-maybe sub-3:05-in a fall marathon next year.

Video: Genetic Testing Could Reveal Risks For A Deadly Form Of Breast Cancer (Newsy)

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