Mulic chose the type of surgery that preserves the outer shell of the breast and, after post-surgical preparation, allows the most normal-looking reconstructed breast possible. "But the main goal is to give Lindsay protection from having another major health problem," Wapnir said. "Breast cancer in any young woman is tragic. In Lindsay, it would have presented some specific problems and limitations in how we would have been able to treat her. Our overwhelming concern was that giving her chemotherapy, for instance, might take her off balance on a multitude of other issues involving her transplant."
The transplant team monitored Mulic's lungs closely before, during and after the surgery. "We look at chest X-rays, lung function analysis, oxygen saturation and the blood levels of the immunosuppressant drugs," Weill said. Mulic's recovery, he said, "was beautiful and the health of her transplant lungs is very good. Here was a young lady facing a very difficult choice," Weill said. "It's very inspiring to see someone confront that directly and make such an informed and inspired choice."
As the days passed after her surgery, Mulic realized that for her, coping with another major physical alteration in her body was not as difficult as her emotional journey, something she had not expected at all. "All over the world, you hear about people going through transplants, but not most people talk about having a double mastectomy. "There were times when I just cried and thought, 'Will I ever get through this?' From a woman's perspective, you're taking away something that means a lot. That's hard."
But she was heartened by the support she felt throughout from her Stanford team. "They said, 'You have the strength to be able to have this surgery. It's the perfect time to do this.' I just trusted them."
Mulic has helped teach Weill and his team more about the longer-term health of people with transplants who are living "longer and longer, developing all the usual health problems that all of us develop as we get older. And as they do that, we're wholly reliant on other teams in other specialties to help us care for them—and that makes our job of keeping lung transplant patients as healthy as possible that much easier."
Wapnir looks at Mulic and sees a young woman whose natural appearing mastectomies have not changed her natural figure—and as someone "who has been released from the burden of yearly MRIs, mammograms or ultrasounds, as well as potential biopsies," she said. "Women like Lindsay now have choices which include prophylactic, risk-reducing operations in order to prevent breast cancer, while preserving at the same time a near-normal body image."
Years ago, Wapnir said, patients like Mulic "would not be here with us. By helping her the way we did, we make it possible for Lindsay to live a long, long time without facing treatment for breast cancer."