My body experiment: beating BRCA2

A competitive athlete on running after a double mastectomy

In our series, My Body Experiment, we ask high performers to tell us about major changes they’ve made in diet, fitness, and general wellness. Here, they chronicle the results of their trials, positive and negative.

When you’ve been an athlete your whole life and find out you’re going to be sidelined for six weeks, it’s a tough pill to swallow. But imagine it’s not a minor injury keeping you from doing what you love—you have a genetic mutation that puts you at a significantly higher risk of being diagnosed with breast cancer in your lifetime, and the best way to prevent that outcome is major surgery. New York City-based runner Caroline Plank, 29, faced that obstacle and chose to take on a huge fitness feat shortly thereafter: running the New York City Marathon. This is her story.

She believed she could, so she did. You’re my sunshine. Expect miracles. I looked down at these three mantra bands, given to me by my mother, as I lay in the hospital bed.

Flashback to 2011, when I was 22: I decided to get tested for the BRCA2 gene mutation after watching my mom battle ovarian cancer when I was a child and due to my extensive family history with other forms of the disease. My maternal grandfather had pancreatic cancer; my maternal grandmother and paternal grandfather had lung cancer and both my aunt and uncle on my mother’s side were diagnosed with breast cancer. I found out I had the mutation, which put me at a much greater risk of getting cancer. My oncologist told me me it wasn’t a matter of if I got cancer but when.

I waited several years after getting the test before considering surgery, but when I found a lump in my breast in September 2016, I knew I needed to be proactive. I didn’t want to simply get rid of the pre-cancerous mass; I wanted to prevent breast cancer altogether. At the time, there wasn’t much information out there about what to expect with a double preventative mastectomy, so I turned to blogs. I went down the Reddit rabbit hole and saw posts saying that I’d never be able to run again, that I wouldn’t be able to do another push-up. It was disheartening. But tell me no and I’m going to show you that I can do it. I resolved to run my first marathon in New York City in November 2017 and qualify for Boston.

I had the surgery on December 2, 2016. During the procedure, the doctors found signs of pre-cancer elsewhere and removed two lymph nodes, which increased the surgery time and thus took a greater toll on my body. I opted for silicone implants, which were inserted during the surgery itself. I didn’t need expanders (a reconstruction technique that is used to stretch the skin if you decide to go bigger than your natural breast size). It’s more painful to go directly to implants since the stretching happens all at once, but I knew I wanted to stay my same cup size and be able to get back to exercising as soon as possible.

THE RECOVERY

In May 2013, Angelina Jolie shared with the world that she had the BRCA2 gene mutation. It was comforting to see a woman with such notoriety be vocal about her decision to undergo a preventative mastectomy. However, her recovery process wasn’t publicized. Surgery really takes away your fitness. The first days were incredibly exhausting. Even just sitting up in bed felt like the hardest task—the surgeons cut where your abdominal and pectoral muscles meet so you’re left extremely weak. A nurse would come to the house every day and getting up to talk to her was depleting. My mobility was also limited because I had drains attached to my breasts for two weeks, which removed excess blood and tissue.

I’ve been an athlete my whole life and played Division 1 soccer in college, so it was really hard when I couldn’t exercise for six weeks post-op. Instead I focused on going for walks with my dogs. Prior to the surgery, I bought a leash that goes around the waist (a regular one would be too risky if they pulled). The doctors initially said I could run after six weeks, but after having the lymph nodes removed I got lymphedema (swelling) in my left arm, so I had to wait another two weeks. I continued to walk.

Finally, two months after surgery, I joined a local group of runners in the mornings once or twice a week who were so helpful in getting me back into the swing of things. They kept the pace slow for me at first and I focused on regaining my endurance. But building up a base was tough. I felt like I was starting from scratch; I needed to learn how to breathe again and get used to a new body. My breasts felt numb and it was hard to find a sports bra that would work. I found a wireless, higher cut bra from Athleta (you can’t wear a wire because of the incision) that wasn’t constricting.

When I was cleared to do yoga eight weeks post-op, it helped a tremendous amount with increasing my strength and getting more range of motion back in my upper body. People say that you won’t be able to do push-ups again if your implant is under the muscle, but that’s a myth.

Still, the chest tightness is a major factor in the recovery process. It’s like having two heavy paper weights wrapped very tightly around your chest. If I pushed the pace too fast, it was a recipe for muscle spasms. I kept my long runs slow and had to find the sweet spot where I could increase my speed (I was aiming for eight-minute miles for the marathon) without feeling my chest tighten too much. It eased up over time but I can’t lie, I don’t know that I will ever feel 100 percent like my old self and that’s okay. My body is adjusting to its new normal.

FIRST RACE BACK

I signed up for the New York Road Runners Retro 5-miler on June 4, 2017 as my first race post-surgery. I was going up Cat Hill in Central Park when all of a sudden I felt intense pressure on my chest. My diaphragm was trying to expand but my pectoral muscles weren’t allowing it to do so and I had to stop. An ambulance took me to the medical tent and I felt defeated. I started to think maybe all of those blogs had been right.

I took a few weeks to rest and let everything settle down and during that break I started to feel fired up again. I wasn’t going to let this stop me from achieving my goals. I began working with a running coach, John Henwood, who ran in the 2004 Athens Olympics for New Zealand and has helped several women get to the Olympic trials. With his guidance, I adjusted my training. The speed workouts were a lot harder and I was so exhausted after the first session that I needed a three-hour nap.

Instead of doing yoga, John had me focus on more strength-based workouts. While I started doing push-ups eight weeks post-op, I found it was crucial to specifically target my chest and build up my pectoral muscles. John helped me with a fueling strategy; before working with him I would have a piece of fruit for a long run but would find myself crashing. Now, my pre-run go-to fuel is a banana, a Huma gel packet, Nuun hydration tablets, and coffee. I’ve been a vegetarian since college (and vegan for the past two years) and I wasn’t getting enough protein. Since my surgery, I’ve been focusing on adding more plant-based sources into my diet that help sustain my workouts. Most importantly, John encouraged me to listen to my body and prioritize rest days.

From then on, most of the training for the marathon went smoothly—until six weeks out. Surgery leaves your immune system compromised and I came down with pneumonia. I had to take three different types of antibiotics that were pretty heavy duty; they can make you more likely to tear a tendon so I couldn’t run while taking them. As a result, I didn’t have much of a taper period.

THE MARATHON

I was a bundle of nerves on the starting line and couldn’t believe I was finally there. My name was written on my shirt and the crowd support was incredible. By mile 22 I was telling myself don’t worry about Boston, just get up this hill. I didn’t have any tightness in my chest, but I was experiencing the so-called wall that many marathoners talk about. I saw a sign that said just put one foot in front of the other, that’s all. Whoever made that sign, thank you. I concentrated on putting one foot in front of the other and surprisingly when I reached the finish line I seemed to be in decent shape compared to those around me. I had done it. I finished my first marathon less than a year out from a major surgery and I qualified for Boston 2019 with a time of 3:31 (a pace of 8:04 minutes per mile).

My chances of getting breast cancer now are pretty close to zero but I’m still at risk of getting cancer in my lymph nodes as well as other forms associated with BRCA (ovarian, melanoma, and pancreatic). But I’m a true believer that obstacles are put into our way to make us stronger. I probably wouldn’t have run the New York City marathon if I didn’t have the mastectomy. I’d like to improve my marathon time at Boston next year and I’ll always focus on seeing the silver lining no matter what happens.

Ultimately, what I’ve learned from this is that you can still do amazing, monumental things no matter what challenge you face.

Caroline Plank lives in Brooklyn with her fiancé Trevor and their rescue dogs. She’s a speech language pathologist and regional manager at Language Fundamentals. For more on her journey, check out her website and watch her documentary.