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“One-size-fits-all” mastectomy is a thing of the past. Women
with breast cancer (and those with increased risk for the disease) have more
options than ever before. If
you’re considering a mastectomy, learning about these latest trends can empower
you to have an open and honest conversation with your doctor, and to make the
right decision for you.
1. More women are choosing preventive mastectomy.
Women are increasingly choosing mastectomy not only for their
one breast affected by cancer, but also for the other breast unaffected by
cancer.
Mastectomy involving both breasts is called a contralateral
prophylactic mastectomy (CPM.) “Contralateral” means the opposite side. “Prophylactic”
is another word for preventative or precautionary. The percentage of women
opting for CPM has increased from 1.9% in 1998 to 11.2% in 2011.
Some women choose CPM because they have a gene mutation that
increases their risk of breast cancer (BRCA1 or BRCA2). Some women choose CPM
because it lessens their anxiety about breast cancer recurring, which improves
their quality of life.
The likelihood of breast cancer returning is lower with a
mastectomy than with a lumpectomy. Of women who
choose lumpectomy or mastectomy for only the breast with cancer, 3% to 9% will develop
cancer in the other breast. However, survival rates are the same whether
the healthy breast is removed or not.
CPM is a more involved surgery than a lumpectomy or a
mastectomy on one breast (unilateral mastectomy). It’s important to weigh the
risks of any major surgery with the expected benefits.
2. More mastectomies are being performed on an outpatient
basis.
The
rate of outpatient mastectomies for both breasts (bilateral) was five times
greater in 2013 than in 2005. During the same time period, mastectomies for one
breast (unilateral) nearly doubled. Some women have expressed a high level of
satisfaction with outpatient surgery and have reported faster healing and
recovery at home with their families.
It
is not yet known whether the overall outcome with outpatient surgery is
different from the outcome of inpatient surgery. A mastectomy is major surgery
with risks and potential benefits, whether it is performed in an outpatient
setting or in a hospital. Your doctor can help you weigh the risks and benefits
of each scenario.
3. Breast reconstruction after mastectomy is
improving.
Some
women choose breast reconstruction to improve their body image and emotional
well-being. Other women do not choose reconstruction because they are concerned
about how their breasts will look. Loss of sensation is also a factor to
consider. Advances in the reconstruction techniques performed by plastic
surgeons aim to make the size and shape of both breasts match and create a
natural appearance.
Every
woman who has breast cancer has the right to choose what she believes is the
best course of action to treat her breast cancer and support her quality of
life. To make the most-informed decision, talk with your doctor about
all your choices and don’t be afraid to seek a second opinion.