Extra mastectomy may not extend life for some breast cancer patients
NEW YORK (Reuters Health) – – For some women with early stage breast cancer, removing the healthy breast likely doesn’t afford much of a survival benefit, according to a new study.
There are several recent articles describing the choice to have a bilateral mastectomy as a poor one.
Here’s another one: The cost of peace of mind: A case of unneeded bilateral mastectomy
MIRANDA FIELDING, MD | CONDITIONS | JANUARY 10, 2014
Many of the articles cite the lack of improved disease-free survival and the increase in potential complications resulting from additional surgery. While these are valid points, the authors of such articles seem to fail to realize that a woman’s choice to have a bilateral mastectomy may have absolutely nothing to do with extending life. In fact, my choice to have the bilateral mastectomy had NOTHING to do with extending my life but rather improving my QUALITY of life.
When faced with a breast cancer diagnosis, what truly are the surgical options available?
Let’s talk about mastectomy with no reconstruction as a ROUTINE option. It should be offered, in my opinion, right along side DIEP flap, silicone implants, saline implants, etc…. Simply number X in a menu of options following the mastectomy, whether it be single or double.
Let me write a minute about my own treatment experience.
First – I had chemotherapy BEFORE surgery. This is a huge deal as it gave me more time to come to a decision about the surgical phase of treatment. I cannot imagine how it must feel for patients who receive their diagnosis just days before the surgical phase of their treatment happens. People are expected to become sufficiently educated within days about surgical options and then choose the best surgical option for their situation. Can you imagine? I cannot. I’m grateful that I had chemotherapy first, which lasted months but left me feeling confident that my surgical plan was the right one.
Second – no one pressured me to “save” my healthy breast nor towards reconstruction. They did ask me if I was sure… I said yes. They also asked me if I was sure once chemotherapy was complete. I said I was. I knew right off the bat that flat was going to be the best option for me. I asked that no extra skin be left behind – I wanted the flattest result possible.
Why did I want a bilateral mastectomy? First and foremost – I wanted symmetry. Second – I did not want extra surgical procedures. Reconstruction often requires multiple surgeries: the initial mastectomy and placement of tissue expanders (which can be delayed or immediate), the placement of the final implants… A minimum of two surgeries can get a person from the mastectomy to an implant-breast – assuming no complication. If the patient wants nipples, that is another surgery. If there are complications, the reconstruction can require additional surgeries and sometimes additional surgery to remove the implants or attached tissue all together. Reconstruction is a tough road with no guarantees, and I was not interested in traveling it. Add to that – reconstructed breasts do not last forever – many are faced with additional surgery later in life… Third – I knew I would have scanxiety (this is a real word in cancer-world). Every time I would report for mammograms or MRIs, I knew I would feel stressed out, no matter how unlikely a second primary breast cancer was. That wee little “what if” part of the brain is difficult to shut up. Now? I’m mammogram-free – for life! I require fewer screening procedures, which is a nice bonus, I must admit.
Why else might a person want a bilateral mastectomy? Well, I have to admit, the lack of bras in my life is quite wonderful. I also find running and jumping far more pleasurable – even the simple act of rolling over in bed is nicer. And, compared to my reconstructed counterparts, it seems I have a lot more sensation than they do. Also, if I want to have the appearance of breasts, I can use prostheses on demand (almost – I don’t actually own any).
Is it all rainbows and unicorns? No – there are some clothing options I feel are unavailable to me… I just look funny in certain things… I do get comments about being flat (the things people will actually allow to come out their heads never ceases to amaze me). And I do miss my nipples quite a lot.
Net win, however.
Given that crappy situation, and let me be clear – it was a crappy situation, I feel that bilateral mastectomy with no reconstruction was the best choice for me. I think this choice is a deeply personal one, and I cannot say what choice is right for another… but I can say – with confidence – that the menu of options should be more inclusive.
For some of us, the best surgical plan includes reconstructing breasts… For others, it means a single mastectomy. For others, it means lumpectomy plus rads in order to save as much of one’s breast(s) as possible. For yet others, it means bilateral mastectomy…. For me – it meant bilateral mastectomy with no reconstruction. I have no regrets regarding that decision.
Finally, articles and discussions about our choices should be more holistic and less judgmental. There’s more to a treatment plan than simply extending life. Quality of life matters too! Health care providers should be asking us – what is your best hope for surgical outcome? What is your worst fear for surgical outcome? And they should listen and work with us to develop the best treatment plan for extending our lives and preserving our quality of life!