Angelina Jolie was back at work preparing for her next film just four days after having a double mastectomy, her doctor has revealed in a detailed description of the actor's months of treatment.

The Oscar-winner underwent her double mastectomy on 16 February at the Pink Lotus Breast Centre in Beverly Hills, California, as the second of three operations to reduce her risk of breast cancer from 87% to 5%.

"On day four after her mastectomies I was pleased to find her not only in good spirits with bountiful energy, but with two walls in her house covered with freshly assembled storyboards for the next project she is directing.

"All the while she spoke, six drains dangled from her chest, three on each side, fastened to an elastic belt around her waist," wrote Dr Kristi Funk in a lengthy and intimate blogpost on the centre's website that explained what Jolie underwent before, during and after her three surgeries.

Despite her fame and constant trailing by the media, Jolie's medical treatment had remained a secret until Tuesday, when she wrote about her decision in an article in the New York Times.

She earned praise from breast cancer experts for flagging up the heightened genetic predisposition to the disease run by women who have inherited a faulty version of either the BRCA1 or BRCA2 gene from one of their parents.

Jolie approved Funk's account of her treatment to help women at high risk because of their family history of either breast or ovarian cancer to understand what is involved if they opt to undergo surgery rather than regular scans and preventive drugs as a way of managing their risk.

Jolie's first operation, on 2 February, was a "nipple delay", a procedure to rule out the presence of cancerous cells in the milk ducts around the nipple in women who have decided to preserve their nipples while almost all their breast tissue is removed during the mastectomy.

"Her partner [Brad Pitt] was on hand to greet her as soon as she came around from the anaesthetic, as he was during each of the operations," said Funk.

Tests showed no sign of cancer.

During the mastectomy a fortnight later, a plastic surgeon called Dr Jay Orringer also "performed the first stage breast reconstruction by placing tissue expanders with allograft", which Funk describes as "synthetic sheets of material, that create a more natural look" for women having their breasts rebuilt.

Despite an extra operation being involved to fit the tissue expanders, Jolie chose to have them, because they help maximise blood flow to the breast skin and nipple, said Funk.

Ten weeks later, on 27 April, Jolie received breast implants during her third and final surgery, the reconstruction, "which went extremely well, bringing an end to her surgical journey".

Funk also detailed the myriad medications and supplements which Jolie took to help her wounds heal after each operation, reduce the risk of infection, lessen post-operative nausea, vomiting, swelling and bruising, get the anaesthetics out of her system, increase the amount of oxygen reaching her skin and minimise scarring.

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Angelina Jolie Praised for Bravery in Mastectomy Revelation - "I hope that other women can benefit from my experience," Angelina Jolie wrote in a powerful op-ed article Tuesday, explaining her decision to go public with having her breasts removed to avoid cancer.

But amid the accolades for the film star's courageous revelation, doctors and genetic counselors were careful to note that her medical situation -- an inherited genetic mutation putting her at high risk of breast and ovarian cancer -- was very specific, and that her course of action made sense for only a small category of women.

Still, they hailed her bravery and said that she would surely help increase awareness and thus, perhaps, help save some lives.

"Having this conversation empowers us all," said Rebecca Nagy, a genetic counselor who works frequently with women who test positive for a defective version of the BRCA1 gene, as Jolie did. "It's wonderful what she's done."

In a stunning op-ed piece in the New York Times, Jolie, 37, began by speaking of her late mother, Marcheline Bertrand, who died of cancer at 56, before she was able to meet most of her grandchildren.

The actress revealed that beginning in February, she underwent three surgeries which she succeeded in keeping secret from the public in which her breasts were removed, and later replaced by implants.

"I wanted to write this to tell other women that the decision to have a mastectomy was not easy. But it is one I am very happy that I made," Jolie wrote. "My chances of developing breast cancer have dropped from 87 percent to under 5 percent. I can tell my children that they don't need to fear they will lose me to breast cancer."

The actress also hinted that she might, at some point, have her ovaries removed, saying that she had "started with the breasts" because her risk of breast cancer was higher than that for ovarian cancer. She did not say how long ago she was diagnosed with the faulty gene.

While admiring Jolie's straightforwardness, cancer surgeons and others in the medical community were quick to point out that hereditary cases of breast cancer account for only about 5 percent to 7 percent of all cases diagnosed each year. And those connected to the BRCA1 and BRCA2 genes are an even smaller group.

And so, women shouldn't just run off and get tested for those genes, said Dr. Robert Shenk, medical director of the Breast Center at the University Hospitals Case Medical Center in Cleveland.

"My worry is that people will be inappropriately tested," said Shenk. "Awareness is great, but people shouldn't just run in off the street and get a test."

Instead, he said, genetic counseling, including a close review of a patient's family history, is crucial.

Nagy, the genetic counselor, who is also president of the National Society of Genetic Counselors, agreed.

"The clues are in the family history. Has there been cancer in multiple generations?" she said. "Are there clusters of cancers, like breast and ovarian, on the same side of the family? Has the cancer been diagnosed at an early age -- under 50?"

If those factors exist, Nagy said, she conducts a thorough risk assessment with the patient. And if testing is warranted, there still needs to be some thought beforehand as to what one might do with the information.

"It might not necessarily be surgery," Nagy said. "It might be much more frequent screenings. Surgery isn't right for everyone."

That's the decision that Gabrielle Brett made at least initially. Brett was only 23 when she tested positive for the BRCA1 gene. She had just met her future husband, James, a month earlier. She wanted to have a family, so she waited.

But at age 29, her husband said she shouldn't wait any longer. She should have her breasts removed before they had kids, even though she wouldn't be able to nurse them. She ultimately agreed. She had the surgery and then had two children. Now 35, she is two weeks from her due date with her third.

Brett woke up in the middle of the night Tuesday, read about Jolie's article on Facebook, and excitedly woke her husband. "It's amazing to hear that someone so famous went through the same thing," she said in a telephone interview. "It makes me realize we are all on the same journey."

Brett, who lives in Shaker Heights, Ohio, also figures that Jolie went through some tough moments, however serene she sounded in her article.

"I'm sure it wasn't quite so simple," she said. "There's sadness, anger, fear. I did a lot of crying alone in the car. But once I had the surgery, I felt a huge weight come off of me. I was no longer worrying whether there was cancer growing inside me somewhere. I felt nothing but relief."

And, she said, it was crucial that she was accompanied throughout her journey by "my own Brad Pitt" -- her husband, who was there through every moment, as Jolie says partner Pitt was for her at the Pink Lotus Breast Center in southern California.

There is one part of the journey Brett has not tackled yet: removal of her ovaries. That, she said, will come a bit later, when she is 40.

Doctors stress that no one solution is right for everyone who tests positive. And even for those with a risky family history, it's not necessarily always right to test right away, they say.

"You don't necessarily want to test an 18-year-old, sending her into a panic at such a young age," said Shenk. "You might consider that she's unlikely to get cancer in her 20s. You would maybe test her later."

Another potential downside to the testing: the cost, which can reach $3,000, though it's usually covered by insurance and there are programs for women who can't afford it.

And some women might simply not be prepared for the results, said Dr. Eric Winer, head of the breast program at the Dana-Farber Cancer Institute in Boston. "Once you get the information, you have to be able to deal with it," he said.

If one does test positive, Winer stressed, it could be a reasonable solution to undergo intensive surveillance with MRI tests and mammograms. Or, some women choose to remove only their ovaries, which in pre-menopausal women seems to reduce the risk of breast cancer, too.

But in Jolie's case, Winer said, it's hard to argue with her choice of preventive surgery. "I tend to be a less-is-more doctor," said Winer. "But I do think the choice she made is a rational, reasonable one."

There is a risk, he noted, that with the actress's celebrity power, people will see her choice and think it's the only one. If they do get cancer, "most women are well-served by conservative surgery, as in a lumpectomy," with chemotherapy and/or radiation, he said.

But any risk is outweighed by Jolie's ability to promote awareness, Winer added. "The more people who ask their doctors about this, the better."

Dr. Kristi Funk, founder of the Pink Lotus Center where Jolie was treated, agreed.  "We hope that the awareness she is raising around the world will save countless lives," Funk said.

Jolie's most positive influence, some say, may be in the fact that such a glamorous woman has come forward -- in great detail -- to talk about how one can lose one's breasts and still remain, well, a woman.

"I do not feel any less of a woman," Jolie wrote in her article. "I feel empowered that I made a strong choice that in no way diminishes my femininity."

That impressed Nagy, the genetic counselor. "For women, so much is tied to sexuality, to sensuality," she said. "Many women feel defined by that. So for her to be such an icon and come out and say, `Look what I did' -- I'm hoping that prompts other women to have conversations, about their own options."

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Angelina Jolie says she underwent a preventive double mastectomy earlier this year after learning she carries a gene that increases her risk of developing breast cancer and ovarian cancer.

In a New York Times op-ed published late Monday, the 37-year-old Academy Award winner writes that after genetic testing she learned she carries the "faulty" BRCA1 gene.

The risk of developing cancer due to the gene varies, but Jolie says doctors estimated she had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer.

Angelina Jolie whose mother, actress Marcheline Bertrand, died from cancer says she decided to have the preventive mastectomy to be "proactive" for the sake of her six children with her partner, Brad Pitt.

"My mother fought cancer for almost a decade and died at 56," Jolie writes. "She held out long enough to meet the first of her grandchildren and to hold them in her arms. But my other children will never have the chance to know her and experience how loving and gracious she was."

Jolie said she has kept the process private so far, but wrote about with hopes of helping other women.

"I wanted to write this to tell other women that the decision to have a mastectomy was not easy," she writes. "But it is one I am very happy that I made. My chances of developing breast cancer have dropped from 87 percent to under 5 percent. I can tell my children that they don’t need to fear they will lose me to breast cancer."

She is anything but private in the details she provides, giving a step-by-step description of the procedures. She writes that between early February and late April she completed three months of surgical procedures to remove both breasts.

"My own process began on Feb. 2 with a procedure known as a 'nipple delay,'" she writes, "which rules out disease in the breast ducts behind the nipple and draws extra blood flow to the area."

She then describes the major surgery two weeks later where breast tissue was removed, saying it felt "like a scene out of a science-fiction film," then writes that nine weeks later she had a third surgery to reconstruct the breasts and receive implants."

Many women have chosen preventive mastectomy since genetic screening for breast cancer was developed, but the move and public announcement is unprecedented from a star so young and widely known as Jolie.

She briefly addresses the effects of the surgery on the idealized sexuality and iconic womanhood that have fueled her fame.

"I do not feel any less of a woman," Jolie writes. "I feel empowered that I made a strong choice that in no way diminishes my femininity."

She also wrote that Brad Pitt, her partner of eight years, was at the Pink Lotus Breast Center in Southern California for "every minute of the surgeries."

Jolie, daughter of Hollywood luminary Jon Voight, has appeared in dozens of films including 2010's "The Tourist" and "Salt," the "Tomb Raider" films, and 1999's "Girl, Interrupted," for which she won an Academy Award.

But she has appeared more often in the news in recent years for her power coupling with Pitt and her charitable work with refugees as a United Nations ambassador.

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Angelina Jolie's directorial debut, In the Land of Blood and Honey, was intended to remind the world of the horrors the Bosnia war which began 20 years ago, and trigger a debate among Bosnians over what happened and why. But it has succeeded most in exposing the depth of the rifts in a country that many fear is moving away from reconciliation and drifting once more towards dangerous instability.

Since the film opened, with a peace award at the Berlin film festival on Monday and a premiere before 5,000 people in Sarajevo on Tuesday night, Jolie and several Serbian members of the cast have received threats.

"There were things sent to me, there were things posted online," Jolie told the Guardian in an interview in Sarajevo. "The cast … have never complained to me about these threats but I've heard through other people it was happening … one of them did have their windows smashed in on their cars and someone else had an issue when their phone was hacked and emails were sent out saying they were from them and saying they had been hurt."

"It was a scary thought that someone was thinking along those lines," Jolie said, adding that she had given the multiethnic cast the option to leave the region, where In the Land of Blood and Honey is being shown for the first time this week, but that none of them took up the offer.

Jolie has abandoned a plan to attend a premiere of the film in the Serbian capital, Belgrade, but denied it was a direct result of the threats.

"The physical threats are not what most bothered me because I have been to so many different countries where there are different kinds of threats, being in Afghanistan and other places as an outspoken American woman," she said.

"It was more that … with a film like this, you don't want it to be used as a tool … especially in an election year, where people are deciding to label it without having seen it, and try to incite aggression and violence."

The film depicts the pre-war romance between a Muslim artist, Ajla, and a Serbian police officer, Danijel, which becomes progressively more twisted and degraded by the conflict.

The lead male role is played by Goran Kostic, who, like Danijel, is a Bosnian Serb from Sarajevo and the son of a senior Serbian officer.

"Some people would give me grief if they knew how to get to me," said Kostic, who spent the war in London and now lives in France. He said his father and other relatives had fought in the war but had not committed crimes.

"They see it as they were fighting a just war," the actor said. "My father is a professional soldier and is unhappy about what was done in the war. He believed he was doing something for the Serb nation but it was hijacked."

Kostic said his family supported him in the face of allegations of treachery from other Serbs, but conceded that his father had yet to see the film himself. Asked how the retired colonel was likely to respond, Kostic replied: "I don't know. We will have to talk."

In the Land of Blood and Honey is a stark, brutal and often shocking portrayal of the war. It shows summary executions and the systematic rape of Muslim and Croat women by Serbian officers at one of the many camps set up around the country. After being separated by the outbreak of war, Ajla is brought to a camp where Danijel is the commanding officer.

As many as 50,000 Bosnian women, mainly Muslim, are thought to have been raped in the course of the war. The Hague tribunal on Balkan war crimes declared it a "crime against humanity".

An estimated 100,000 people were killed in the war, including 8,000 Muslim men and boys murdered at Srebrenica in 1995, which the Hague tribunal has declared an act of genocide.

The current Bosnian Serb leadership rejects the findings of the tribunal and other international investigations, and Jolie's film is not being shown in the Republika Srpska, the Serbian entity which makes up more than half of Bosnia.

Vladimir Ljevar, who runs a multiplex cinema in the main Serbian city of Banja Luka and controls much of the cinema distribution in the Republika Srpska, told the Guardian: "I have seen the film at a screening for distributors in Belgrade. The impression I had of the movie is definitely lousy."

Ljevar added: "I wish I had a multiplex cinema in Sarajevo so I can also make a profit on it. Here I cannot. There are simply some films that are acceptable for Sarajevo, but not for Banja Luka."

In the small snowbound town of Pale, the Serbs' wartime capital about 12 miles from Sarajevo, a group of law students all said they had no intention of going to see the film.

Zeljko Stankovic, who was just two when the war started, said: "It would be an uncomfortable feeling. How would an American feel about watching a film with Americans portrayed doing things like that?"

Back in Sarajevo, where the film was greeted by a standing ovation in a former Winter Olympic stadium, Jolie argued against the suggestion that the film had failed because of its rejection by most Serbs, pointing out that some people in Republika Srpska were trying to get hold of the video independently.

"If anything, it has proven what is happening in the country. It has reminded people of the complications of the region, of the way people view each other. And also many people have risen up like these people who are doing private screenings in their homes," she said.

"Many people have written to me. People are speaking up and not allowing someone to tell them how they should feel about the film, about each other, about history, and I think this is the extraordinary thing."

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Fresh off of attending the Cinema for Peace Gala in berlin, globe-trotting power couple Angelina Jolie and Brad Pitt were spotted arriving at the Sarajevo airport on Tuesday (February 14).

The trip comes as the "Salt" actress is set to attend the debut screening of her movie "In the Land of Blood and Honey" about the war in Bosnia.

She and her "Fight Club" partner will be attending a press conference while screening the movie in Zetra Olympic center on the Valentine's Day holiday.

And while 5,000 people are expected at the debut in Sarajevo, it's being told that Serbs want no part of the film - with Vladimir Ljevar telling The Associated Press, "There is simply no interest for this movie here, so I can't sell any tickets."

The sole film distributor added, "The fact that the Serbs are the bad guys in it is the reason why there is no interest. The film is lousy. I watched it. It has had bad reviews. It is unprofitable."

Angelina Jolie and Brad Pitt arrive at the Sarajevo airport February 14.

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As she developed her story about lovers on opposite sides in the Bosnian War, Angelina Jolie drew on everything she had learned traveling to combat zones. But she started at home, imagining herself and partner Brad Pitt at such extremes.

"In the Land of Blood and Honey," Jolie's writing-directing debut, hurls two lovers — a Bosnian Muslim woman and a Bosnian-Serbian man — from their tender relationship before the war into the horrors of work and rape camps, where brutality, betrayal and degradation are daily matters.

"The closest relationship in my life is Brad," Jolie said in an interview for the film, which opens in limited release Friday and expands in January. "It's the man-woman relationship. So for me to put myself in a position to be able to write from, it would be, well, what if it was me, and what would it be like? And what would it take? Could I ever turn on him? Would this ever happen? Would he ever turn on me? So you try to put yourself inside, and that's how that relationship started."

The result is worlds away from the vanity projects some superstars end up with when they play at directing. Jolie holds nothing back in depicting the savagery of the war that followed the breakup of Yugoslavia in the 1990s, as ancient ethnic rivalries reignited after decades of communist rule.

As a goodwill ambassador for the United Nations, Jolie, 36, had visited Bosnia and felt a growing compulsion to help dramatize a conflict about which the world at large had been misinformed or even indifferent.

When the war broke out, Jolie herself was a teenager with other things on her mind than conflict in a distant land.

"I was being a 17-year-old. I knew only a little bit about it," Jolie said. "It just felt very far away, and until America got involved, I don't even remember any headlines in our papers."

As the years passed, Jolie remained busy with other preoccupations — Hollywood party girl, Academy Award winner for "Girl, Interrupted," marriages to actors Jonny Lee Miller and Billy Bob Thornton, the latter a wild love affair that was a gold mine for gossip tabloids.

Then came the action comedy "Mr. and Mrs. Smith," in which Jolie and Pitt starred as married assassins gunning for each other. Home-wrecker headlines followed as Jolie took up with co-star Pitt, who ended his marriage to Jennifer Aniston.

Jolie already had begun her humanitarian makeover, adopting a child from Cambodia and using her celebrity to shine light on children in peril, the plight of refugees and other causes around the world.

As she and Pitt's family has grown — they now have three adopted and three biological children — Jolie's image has transformed from sinner to saint.

"I've always tried to step outside my comfort zone. Sometimes that can be good and useful for hopeful things like this," Jolie said, referring to her film. "And sometimes, when you're younger, it can be very destructive and a bad thing."

Visiting war zones changed her perspective, but it was the home front — taking on children — that made the big difference.

"That was what changed me completely, and then I knew that once you decide to become a parent, you can no longer be in any way self-destructive or selfish. You live for someone else, and it's over. It's all over," Jolie said, laughing.

"But in the greatest way, because the chaos — no wild days as a punk are ever as interesting or as chaotic as my life with my children is now. They can out-punk anybody you know."

Jolie said she wrote the screenplay for "In the Land of Blood and Honey" as a private exercise, but once Pitt read it, he told her to put it into circulation and get some feedback.

Without her name attached, she sent the script to people on all sides of the Bosnian conflict. The response was favorable, and before long, Jolie was casting actors, mostly people who lived through the war or had close relatives and friends in the thick of it.

Cast as Muslim artist Ajla, Zana Marjanovic was 8 years old when the war broke out. She and her mother fled to Slovenia while her father stayed behind in Sarajevo. Goran Kostic, who was 20 and living in London when the war started, was cast as Ajla's lover, Danijel, torn between love and duty as a leader at the camp where she is interned.

With graphic scenes of rape, sniper slayings, civilian massacres and soldiers using women as human shields, the film was a balancing act as Jolie sought to tells a story representing all sides.

Jolie's reputation as a humanitarian envoy reassured the locals that the film would be a fair and honest depiction, said Marjanovic, who recalled the stir created by Jolie's visit back to Sarajevo last summer for a film festival.

"We're just too cool to be concerned about various superstars walking around our city," Marjanovic said. "But when it was Angelina — that was just the one superstar we're not immune to. It wasn't only because of everything she's done as an actress — it was that and the fact that she's doing this film about Bosnia. I think everyone had really high hopes, and I believe they'll feel that it came from the right place, that she will portray us truthfully and do a great job."

At U.S. theaters, the film mostly will play in a Bosnian-language version with English subtitles. But Jolie and her actors shot a second version in English that's available for domestic and overseas markets where subtitled films might be a hard sell for audiences.

She prefers that viewers see the native-language version, but the English one is "there for whoever wants it, because we want to reach as many people as we can," Jolie said.

Jolie eventually wants her children to see "In the Land of Blood and Honey" — though for now, she's keeping them on a cinema diet that includes her "Kung Fu Panda" animated tales.

Of her own movies, "I think the most fun one for them will be 'Mr. and Mrs. Smith,' because who doesn't want to see their parents try to kill each other?" Jolie said. "'Wow, mom and dad are going crazy.'"

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