What do reality-TV star Sharon Osbourne and Miss District of Columbia Allyn Rose have in common?

Miss D.C. Allyn Rose (Miss District of Columbia Scholarship Organization)

Rose has said she plans to have a double prophylactic mastectomy after she competes in the Miss America pageant in January (or, if she wins, after her reign concludes in 2014). Rose lost her mother, who was 50, to breast cancer in 2004; her mom had first been diagnosed and treated for the disease when she was 27. Rose reportedly does not carry the BRCA genes but has another genetic predisposition to breast cancer.

Osbourne, 60, and Rose, 24, join the ranks of women whose risk of breast cancer is deemed greater than that of the average woman and who would rather lose their breasts now than their lives to that disease later.

Those ranks include Sharon Kulik, 60, of Clarksville, Md. and her daughter Jennifer Kulik, 28, also of Clarksville. Sharon Kulik, now a retired teacher, lost a sister to cancer in 1994. Her sister had been diagnosed with breast cancer at age 30 and ovarian cancer at 34; she was 37 when she died. Sharon Kulik tested positive for the BRCA1 gene. After that, she “was paralyzed every time” she had a mammogram, fearing a cancer diagnosis. “I wanted to do something proactive” and began researching options for surgery, she said.

Her quest led her to C. Andrew Salzberg, a plastic surgeon with offices in the Hudson Valley area of New York, who specialized in a procedure in which removal and reconstruction of the breast are achieved in a single step.

The more common approach involves a first surgery in which the breast is removed and a tissue expander placed on the chest wall behind the pectoralis major muscle. The expander must be enlarged over several months (requiring multiple office visits) until the breast tissue can accommodate the implant, which requires a second surgery.

The one-step procedure Salzberg performs uses processed, sterile cadaver skin to hold an implant in place right away. The surgery also spares the patient’s nipple and surrounding skin. Salzberg says the procedure, which he’s been performing for about 12 years, costs about $20,000 to $25,000 and that insurance covers those costs for women with BRCA1 or BRCA2 genes.

Sharon Kulik was pleased with her results: “It’s the best thing I have ever done for myself,” she says. “I was able to put the issue of breast cancer behind me. Until, of course, my daughter was tested and came out positive.” Jennifer Kulik had her surgery, also with Salzberg, in August 2012, seven years after her mother’s surgery.

According to the American Society of Plastic Surgeons, the standard of care for mastectomy and reconstruction remains the multi-step procedure involving placing a tissue expander under the muscle. That could change as more surgeons adopt the newer technique and their results build a bigger body of evidence supporting its use. Single-step procedures are also performed at Johns Hopkins Hospital; both that hospital and Salzberg note that single-step procedures are not appropriate for all patients and that women should review their options with a surgeon. Radiation and chemotherapy, for instance, can influence the choice of reconstructive technique.

The ASPS has mounted an initiative to help women better understand all their options when it comes to mastectomy and reconstruction. Read more about those options and the ASPS’s education efforts here.

For more information about hereditary breast cancer, check the Web site for the nonprofit organization FORCE (“facing our risk of cancer empowered”), which is “dedicated to improving the lives of individuals and families affected by hereditary breast and ovarian cancer.”