Dorothy: [00:00:00] Rachel Evans made one of the most difficult choices a woman can make. She chose to undergo a mastectomy due to a positive BRCA1 gene mutation. During this episode, Rachel talks about the emotional and physical challenges of surgery. And the impact it had on her femininity and on her ability to breastfeed.
Rachel emphasizes the importance of research and of information for women considering reconstruction after mastectomy. And she opens up about the support she received from her husband, who is also a cancer survivor. And she shares her hopes for her children. And she wants to remain positive and informed. And she wants them to be informed about their health.
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Rachel, thank you so much for being with us here today. I’m I am just so delighted that you have the courage to share your story because, uh, some of the decisions you had to make, most young women would not even dream they would have to do that. So let’s start back with, uh, tell me just a little bit about you, what, what you’ve done. Where you are in, in, in your life right now.
Rachel: Yeah, so, I grew up in Houston, uh, had a great, um, family with my mother, my father, and my brother. Um, I wasn’t around when my mother had [00:02:00] cancer the first time, but we were always surrounded by a community. Um, a lot of the times it was with Susan G. Komen, uh, went to the Race For The Cure, always wore a lot of pink.
Um, so it’s always been, you in our lives, but I had a great childhood. Everything was very normal, went on lots of vacations. Um, later I went to college at Texas Tech University in Lubbock following my brother. I got a fabulous job, um, with the company Camillo companies. I’ve been there for eight years. Um, I got married in 2022, welcomed my first child, little boy named Oliver. And now I’m expecting my second child in June, um, a little girl named Everly. So I’ve accomplished a lot. Um, I’m 30 now, so I have a long road ahead of me and a lot to accomplish ahead of me, but I think I’ve lived a pretty normal life, other than my mastectomy.
Dorothy: Rachel, there’s nothing normal about some of the things that you’ve had to do. [00:03:00] So let’s, for our listeners, uh, just a little background. Your mother was a two time breast cancer survivor, and, uh, she was very young when she was diagnosed. Your brother was just a few months old.
Rachel: Mm hmm.
Dorothy: Uh, and so, she’s, she went through the whole treatment process, um, and she at some point did the genetic testing to find out she had BRCA1, and that really impacted you as a young woman. So You know, it’s interesting you talk about there was always pink around you. So you were very aware of the breast cancer community.
Rachel: Very aware.
Dorothy: Yeah.
Rachel: Um because my aunt had also had breast cancer And I know a lot of my mom’s friends had breast cancer. She was very active in the community Um, and I always thought it was fun to go on walks wake up early wear pink, um and be surrounded by all those women.
So yeah, it was something that I grew up with. Um, it never scared me. It wasn’t till [00:04:00] you know, my Mid to late 20s that I realized, um, how serious it was, um, because everyone that I was surrounded by had beat cancer. I had never known somebody at that point who had passed from cancer. So to me it was just being surrounded by really strong women and people. It was very motivating.
Dorothy: Oh yes. And that’s so different than, uh, just two generations before you.
Rachel: Of course.
Dorothy: You know, there was a time when cancer meant death. There was, you heard the word, you just knew you were going to die. But that’s, that’s so interesting. In your generation, there’s a different understanding of cancer, and you saw more survivors than you knew about people who didn’t make it.
Rachel: I did, and I think it’s too where we grow up, you know, growing up in Houston with having such a great medical center and having MD Anderson, you, you really do hear about the positive stories a lot more. Um, and being surrounded by a lot of women that have gone through [00:05:00] breast cancer that have survived. Um, you hear those survivor stories a lot more than, than you hear the others.
Dorothy: Than you do. That’s so true. So, what made you have the genetic testing?
Rachel: I was always curious. Um, It was always in the back of my mind. I always felt that I had the gene. I don’t know why I’m not a very intuitive person, but I wanted to know. Um, I’d rather know that I have the gene and how to prepare myself.
Um, I, I wouldn’t say that I found out at the, at the best time, I was 21 when I found out. Um, I was, I was eager, um, my aunt had gone through genetic testing, and it was, it was at the front of our minds. I didn’t want to forget about it. I didn’t want to lose the paperwork and not know, where her gene was so that my doctors could easily find it.. Um, so I went ahead and did it and, you know, I’m, I’m in Houston and we have MD Anderson. It was very accessible. So I made the choice. I think I had to wait [00:06:00] like a month to get the results because at the time there was one facility and there may still be one facility that does the testing. Um, but it was 30 days and then I got a call and on that call they said, you are positive. We’re going to have a therapy call or a call just to kind of tell you what this means. So luckily they let it sink in, um, before I had to really digest what this diagnosis meant. Because having a positive gene mutation is one thing. But knowing the age it could impact you, it’s not just breast cancer, it’s ovarian cancer. Um, and the percentage chance of, of, of having cancer, um, it’s scary. So MD Anderson was wonderful about, um, providing a lot of information.
Dorothy: So during those 30 days, was it always top of mind?
Rachel: It was. Um, I knew that I’d get a message in the portal telling me that I’m going to get a call, [00:07:00] but it was top of mind. Um. I was worried, but at the same time, it’s not a cancer diagnosis, and I knew that. I just knew that it was more of a preparation alert. Um, so it was nerve wracking, but I don’t think it changed how I went about my day to day.
Dorothy: So now, two, three years later, you made a very definitive decision. Did your doctor encourage that, or was this on your own, or?
Rachel: So, because my mom had breast cancer so early, um, anytime I went to an OBGYN for birth control or just checkups, we’d always mention it. Um, I lived in Austin for a little while, I lived in Lubbock for a little while, so I had multiple OBGYNs. So I had lots of different opinions, um, lots of different conversations.
Some of them told me to have kids before I’m 30, Um, some of them [00:08:00] told me to try to make a decision by 35, so the clock was ticking. I mean, my mom didn’t have me until she was, I think, 38? So it was kind of a lot of stress to get my life started and to meet a man and to have children. I don’t think that their advice was always the best advice, but at least it Provided me with things to think about.
Dorothy: Yeah, but how did you know they might all not be the best to advise? How did you discern?
Rachel: I mean, I googled a lot. I’m a big Googler. MD Anderson provided a lot of packets of information and seeing numbers like 93 percent chance of breast cancer, 90, percent of ovarian cancer. It’s scary. And a lot of these, when the gene is passed down, the cancer shows up earlier and earlier.
So I knew that I wanted to have the mastectomy. I just didn’t know the best time. There’s never a good time to go through a major surgery. Um, when I graduated [00:09:00] from college in 2016, I was starting a career. I didn’t want to start a career and then have to take off several months for a major surgery. Um, you never know when there’s going to be complications, but when my mother found out that her cancer came back in 2018, I knew the decision I had to make.
Dorothy: But still.
Rachel: It’s tough. I mean, it’s tough to get rid of a part of you as a woman, to take your femininity away. And at the time, I was just thinking of the medical side of it. You know, it’s medically necessary, it’s medically right. You know, I didn’t want to have to go through what she went through with children, with taking time off when you have children.
So I knew I wanted to do it before having kids. But when you go talk to the doctors, it’s all, okay, what size implant? What kinds of implant? It’s never about not having the milk [00:10:00] production. It’s never about, um, how it’s going to make you feel emotionally, physically, how it’s going to make you feel when you have a partner.
Um, and at the time I just had a boyfriend. I wasn’t engaged. I wasn’t married.
Dorothy: Oh my goodness.
Rachel: I was in a new relationship. Um, so it was, it was a lot in one year, but when my mom made the decision to have her mastectomy in October, I wanted to be by her side and I didn’t want her to have to worry about me.
So two months later. I had my mastectomy same year. We got to recover together.
Dorothy: Oh my goodness. How did you say goodbye to your breast?
Rachel: It was hard. I, I like to think I had great boobs. They were, they were small. They were cute. They were perky. I was 25 at the time, so I didn’t know how much I’d miss them. When you look at, When you do your research on what kind of boobs you want and, um, what size, you look at just normal boob jobs. There’s not a lot of imagery out there [00:11:00] for mastectomy, um, reconstruction. I think there should be a lot more. And so you really don’t know what your things are going to look like because they take out all the tissue.
So when I first had my surgery done, I did direct to implant. So they took out all the tissue and they immediately put implants in because I wasn’t going much bigger I was trying to stay the same size that I was before the mastectomy So I didn’t have to do expanders. It was just a lot less to deal with a lot less appointment um, but it was flat chest with two implants.
There was nothing around it to make to soften it— um to make it look natural— it looked like I regretted my decision when I first saw it in the mirror I was like— wow. This looks horrible. Um, but MD Anderson was wonderful. I had four surgeries after that to take fat grafting from my stomach, from my thighs, from my, from my hips, anywhere that you could pull it from, um, to do fat grafting in my [00:12:00] chest to make, to inject more and to make it look more natural.
And so I was really thankful that, one, I had health insurance. I didn’t have to pay anything out of pocket. Um, I think I had to hit my deductible, but that was nothing. Um, that they were willing to continue to do these surgeries to where I felt comfortable and confident and happy with the results. Because the real thing was getting the tissue out. Once the tissue’s out, their job should be done. But they really wanted you to feel confident in your body. And I was very thankful for that. Cause it took four surgeries to get to where I look somewhat natural.
Dorothy: But Rachel, that’s a part of our body. I’m mean—
Rachel: It is.
Dorothy: It is as important as an arm, a leg, you know. I’m delighted that you took that care with you. But a lot of women are told. Well, just be happy that you’re not gonna have cancer. Or just be happy that it’s gone, or. And that’s, that’s not always the case in—
Rachel: No, and I wanted to be grateful. I wanted to, [00:13:00] to be proud of my decision. And I, it, I needed those four surgeries in order to be an advocate for this. And even after the four surgeries, I, I went through a, a small depression because I never felt like a woman. I felt like it was taken away from me, even though it was my choice. I was naive at the time. I didn’t know what decision I think I was making. Looking back now that I have my son and I’m pregnant with my second, I am so grateful that I made the decision I made at the time I made it.
But when you’re 25 and in a new relationship and you don’t feel feminine anymore, it’s really hard. So it took, I would say, six months after all those surgeries to really feel confident again in my own skin and be able to confidently say that I didn’t regret my decision.
Dorothy: Do you have therapy or anything like that?
Rachel: I didn’t. Um, my husband was a great support system. I, I, I didn’t tell my parents or anybody until after the fact because, I mean, [00:14:00] my mother was so strong, never complained. Um, actually having cancer in me, you know, I’m, I’m young, I’m thin, I should be very grateful that I had this knowledge, um, and could act quickly before having cancer.
I felt like it was. Like I was complaining and so my husband was really who helped me through everything, you know, reassured me that I was beautiful. Said it’s okay that you’re not breastfeeding. A lot of women can’t breastfeed. My mother wasn’t able to breastfeed even with milk ducks. So, um, it’s just something that I had to slowly get through and I had to be okay with it myself.
People can tell you time and time again that you look beautiful, that you’re perfect, but you have to believe it. So it just took time for myself to believe it. Um, but I finally got there and I will say. After having my son, you know, your hormones are crazy after you have children. And I was, I just look back and I’m so grateful.
I can’t imagine what [00:15:00] my mother had to go through with having an infinite home, being worried of not being there to see them grow up.
Dorothy: But you did have some regrets when you realized, and of course you knew this, You know, you knew this intellectually, but when you realized you would not be able to breastfeed.
Rachel: Breastfeeding was never something I was excited to do. You hear all these horror stories about mastitis, and how painful it is, and how you’re doing it yourself, that your husband can’t help you because it’s all coming from your own body. So, it was something I always thought I’d be okay with, not breastfeeding.
But it’s when you’re holding your child. That you really want to feed them. And then there was a huge formula shortage in 2022 where we couldn’t find formula. I mean, we were going on to the stores websites every single day. We had family and friends trying to track down formula. My son had reflux, so we had to have specific [00:16:00] formula for him that was very sensitive. He was on medication and I was, I was, I was. And he felt so helpless that I couldn’t feed him. That’s something so natural that women have done for millions of years. I couldn’t do. And so, and its expensive. Formula is not cheap. Um, and getting really good formula is really, really not cheap.
So, it was a scary time. And in that, I think that was my second regret, was just not being able to feed him. Now, if I hadn’t had gone through the mastectomy, who knows if, if I would have produced milk. You just, you just never know these things, but not having had the opportunity that, that was very hard to come to terms with.
You never know what you’re going to want until you’re in that situation.
Dorothy: That is so true. And you know, it doesn’t matter. Those were your emotions. You know, we can, uh, reason them all away and that kind of thing. But when it’s your emotions, it’s your emotions. Now, your husband had his own battle—
Rachel: Yes.
Dorothy: —With cancer .So, did you think that [00:17:00] made him more empathetic? Or—
Rachel: I do. So my husband had, um, stage 4 testicular cancer when he was 18. Um, he was in basic training in the military when he found masses in his um, lungs, his chest, softball sized tumors. He was given, um, a terminal diagnosis. He was given a week to live. He had to go through years of stem cell transplants, chemo, um, miserable, horrible, unspeakable things that you wish no one to go through.
And so I knew when I met him. And when my mom got diagnosed, I didn’t, I didn’t want to be in their shoes. I didn’t want to be a burden to them. I didn’t want to have to deal with what they’ve dealt with hearing their stories and hearing how it’s impacted them. I wanted to be able to use that knowledge because how selfish would it be that I know that I have this gene not to take action when they didn’t have that opportunity.
They didn’t [00:18:00] have that knowledge. So I felt like it would have been really selfish. Um, and my husband was a huge support because he didn’t want me to go through what he went through. Um, and he, to this day he still has a brain tumor. It’s not active, it’s never been active, but it, it causes a lot of symptoms for him. And so I just, I’m very thankful that, Our family can focus on his health and that I’m really healthy and can take the time and help our children and that we can focus on getting him healthy.
Dorothy: So you knew this going in with him, right?
Rachel: I did.
Dorothy: Yeah.
Rachel: I knew what I was signing up for. But he’s a wonderful man. Um, I hope that it has no impact on, his life. Um—
Dorothy: But Rachel, not many people in their teens, 20s have to deal with such life altering decisions and situations. I mean.
Rachel: It’s wild to be surrounded by so much [00:19:00] cancer. I mean, my dad had thyroid cancer, my mother, my aunt. Now my husband. It’s, it’s a lot and I, again, I’m thankful that I have this knowledge now I still have to have children and I still want to go through having a hysterectomy or at minimum getting my fallopian tubes out because I’m not all clear.
I still have my nipples. I did nipple sparing. So there’s still that 2 percent chance of breast cancer, even though small, um, and I still have a chance of ovarian cancer. So it’s not that I’m in the clear. It’s just that I know to do screening a lot earlier. Um, I know that. There are surgeries available in order to try to get ahead of it.
Dorothy: And I’m so glad you didn’t sugarcoat over The, the realization after you had the surgery. I, I think, uh, so many women really don’t research enough. One of the things you said that really struck home is there’s not enough out there that you can see that image after [00:20:00] reconstruction. And it is different. It isn’t just the boob job.
Rachel: And I’m sure a lot of surgeons don’t want to share that information because it’s not pretty. It’s not these beautiful, boobs that you go from flat chested to these beautiful perky— but it’s not. It’s a lot different. And there are scars. Even though they, they are very hidden, it is hard to see. They’re not there. Now, I know MD Anderson took a lot of pictures of me after all my surgeries. And I know that they’re, I’m sure, working on a database of images. But if you just Google, it’s really hard to find this information.
But I think it’s really, really important. Um, and I think that’s really important because I think I would have just had a lot easier time if I would have been prepared mentally because you build up this expectation of how your boobs are going to look and then you let yourself down because you built yourself up.
Dorothy: Yeah, but I think you’re onto something there. We do need a lot more information. Great decision from that medical point of view, but can take its toll in a lot of other ways.
Rachel: [00:21:00] Agreed. Agreed.
Dorothy: So what do you hope for your, for your children as they get older?
Rachel: I hope we keep advancing, um, everything and, and medical to when, if she does get diagnosed or my son too, I mean, men can also have the BRCA gene. Men can also get breast cancer though rare that I, I mean, I know I want them to be tested, but that they’ll wait until they’re ready to be tested. They don’t need to be 21. They don’t need to be 18. Um, it needs to be when they’re ready. I’m not going to push it on them. Um, but, um, And I just hope that they see how strong I was, how courageous I was, how strong my husband is with his, his cancer.
My mother, you know, they’re surrounded by so many strong people that they won’t be scared. I don’t want them to be scared. I don’t want them to be worried. Um, because I don’t think that helps anything. I think having a positive attitude is really what helps you. Um. And so I just want them to remain positive.
I want them to be in the community. I don’t want to hide it from them. [00:22:00] Um, but I also don’t want to hide that it could be, you know, terminal, that it is serious. At the same time, knowledge is power. As long as they know what to expect, and they know to get their checkups, and they know that these, and Resources are available to them. Hopefully they can catch whatever they do have early, if they were to be diagnosed.
Dorothy: Such good information, good advice. Knowledge is power. And that positive attitude, you certainly came by that. Naturally, knowing your mother, my goodness.
Rachel: She’s a strong woman. I know I wrote a paper, I think in fifth grade, about her being my hero. I’m sure that let my dad down a little bit. But, she truly was. She still truly is. She’s, she’s a Huge worker be it was amazing having a mom growing up that worked. It was a great role model. Um, I’m now a career woman, even though I have my son and soon to have my daughter, I’m always going to have my career. I love my career. So it’s really great having somebody so strong, but also. [00:23:00] Not the norm not the woman that just stays home with the kids.
Dorothy: Mm hmm.
Rachel: So I’m very I’m very grateful to have her as a mom.
Dorothy: Yes, and it certainly gave you a lot of different aspects to explore in your young life.
Rachel: Definitely.
Dorothy: Thank you so much Rachel for being with us today and for being so candid about your own experience and what you went through. I think So many women have felt the same things that you did, but maybe weren’t aware, maybe weren’t willing to say, Ooh, this, this was a tough decision. And, you know, even admit that there are times you regret. That’s, that’s a great, great story. Thank you so much.
Rachel: Thank you for having me.
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