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Growing number of women choose preventive bilateral mastectomy

Nicole Smyle, 35, is one of a growing number of women in their 20s and 30s, who are opting to remove their cancer-free breast

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NORTH BAY VILLAGE, Fla. – Nicole Smyle, also known as Ninja Kitty on Instagram, had her first breast cancer scare when she was a teen at Miami Killian Senior High School in Kendall.

She didn't want to deal with doctors, so she waited as long as she could to tell her parents. The tumor didn't go away. It had grown from the size of her thumbnail and into a golf ball. In fear that she was sick, her boyfriend of two years asked her to do something about it.

She met with her parents in her bedroom to reveal the secret. She was not going to tell them about a butterfly tattoo she had managed to get without their consent. It wasn't a problem that anyone would expect a teen to have. She hadn't been suspended from school. She wasn't pregnant. Instead, she was afraid she had a time bomb in her breast.

"My father had a [non-cancerous] tumor removed at a young age. I could see the worry in his eyes … My mom insisted upon playing doctor herself," Smyle, 35, said. "And soon after, she broke out into tears once her fingers touched what I had been hiding."

It wasn't breast cancer. Smyle was starting to go to college at Florida International University when she had her first surgery to remove a fast growing benign tumor from her breast at Memorial Regional Hospital in Hollywood. And it wouldn't be her last. At age 34, she became one of the growing numbers of women, who are opting for prophylactic mastectomies – a preventive surgery to remove a healthy breast.

Some of the women removing their breast have a family history. Some have made their decision to remove them based on knowledge that they carry genetic mutations that increase their risk. At least 1 million have been screened for BRCA1 and BRCA2 mutations since the test became available in 1996, according to Myriad Genetics, the company that developed the test.

Rep. Debbie Wasserman Schultz, Christina Applegate and Angelina Jolie are some of the public figures who have been open about inheriting the 85 percent risk of having breast cancer in their lifetime. Research shows the surgery reduces the risk by at least 95 percent.

Health insurance offers partial coverage of the $4,000 bill of the genetic testing. According to Myriad the out of pocket cost can be less than $100, but some patients have reported having $200 to $300 bills. As far as the cost of the surgery, until the Affordable Care Act passed in 2010, federal laws did not require insurance providers to cover it. In Florida, the treating physician must opt for the surgery.

SLIDE SHOW (Graphic Content) | Scars and cleavage

Smyle was 33 when the breast cancer fear hit again. She felt two tumors during a self-exam, while she was taking a shower.

"It felt like I had two masses growing in my left breast," Smyle said. "In that shower, in that instant, I was flash-backed -- Hot Tub Time Machine style -- to that scared 18-year-old … I knelt down in the shower and wept as fast as the water was beading down my body."

Without health insurance, Smyle decided to go to Planned Parenthood North Miami Health Center, 681 NE 125 St., near the Museum Of Contemporary Art.  The center, which is now closed, referred her to get a mammogram and an ultrasound.  There were four masses. Even though they were non-cancerous, she learned her left breast would have to go.

"Some women have a nice face, others great hair," Smyle said. "I had great breasts."

For a single woman who was still dating, it wasn't an easy decision. She wasn't interested in genetic testing.  The non-cancerous tumors were growing and were causing her pain. She was afraid that the same would happen on her right breast.

 "Am I a woman who can rock one breast and still feel like a woman? As much as I wanted to be this strong I was not …I wish I would have been strong enough to not get implants at all," she said. "We live in a very superficial world. I didn't believe I could find a partner or someone to love me with only having one breast."

Smyle's options for reconstruction are better than the ones that were available to her mother and grandmother. Today breast implants are safer and more comfortable than the ones that were first developed in Texas in the 60s and were widely available in the 70s. New techniques that include using fat, cadaver and pig treated skin and patient's muscle have also improved cosmetic outcomes.

"I was joking that I was going to start doing webcam [modeling] to pay for surgery, but my brother said no way, and helped finance it," Smyle said.

Four days before her 34th birthday, she went in for surgery to remove both breasts. She woke up with two D-cup breast implants.  Without health insurance, she spent roughly $9,000 out of pocket for the surgeries. Recovery was difficult.

"The simplest things were challenging -- from brushing my teeth to washing my hair, to putting a shirt on," she said. "I cried every day. Besides the constant pain from the surgery I was not myself. A big part of me died … I was in such a dark place."

Dr. Leonard Hochstein did an amazing job, she said, but she wasn't prepared emotionally to deal with the difficulties of recovery. She was afraid of the scars and of losing the breast implants. She was having nightmares.

 "I know now why they show you 3, 6 and 9 month post pictures, and nothing in the first three months," Smyle, of North Bay Village, said. "I would panic before applying my scar cream every day. After the first week, I discovered that if I sing Amazing Grace I could get through it., so I did that for a while."

Her skin has healed. She recently celebrated her 35th birthday at Doraku and Juvia, two restaurants in Miami Beach. She wore a sexy black corset that showed off her cleavage. She said she was excited about a job interview that would put her back on track for a career in hospitality.

"This has been the hardest year of my life. Not only getting over this surgery but more so finding myself again; gaining the confidence to stand in front of a mirror and love myself completely," Smyle said. "I am alive. I am healthy now. I have time in this world still and I cannot spend any more of it feeling sad."

Smyle got the job. She was giddy. And she will be working as the lead host for Chef Michelle Bernstein's new restaurant at Thompson Miami Beach Hotel. Her training starts Friday, Oct. 3rd. And you can bet that she will be smiling.

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