April 3, 2017

"One in three breast cancer patients under 45 removed the healthy breast along with the breast affected by cancer in 2012..."

"... a sharp increase from the one in 10 younger women with breast cancer who had double mastectomies eight years earlier, a new study reports."

The NYT reports in an article that attributes the decision to irrational fear.

But there's a link in the sidebar, under "related coverage," to a piece from last October, by the same reporter, Roni Carin Rabin, titled "‘Going Flat’ After Breast Cancer," about women choosing not to go through breast reconstruction after a mastectomy. This article — with many photographs — celebrates the post-mastectomy, unreconstructed look. But all of these women have had both breasts removed.

Putting the 2 articles together, I would guess that at least some of the women opting for a double mastectomy are at least partly thinking about the aesthetics of symmetry. The new article does have this:
Researchers initially thought that women would be more likely to choose a double mastectomy in regions where reconstructive surgery is more commonly done because they wanted symmetrical reconstructed breasts, but many states with high rates of double mastectomies do not have high rates of reconstructive surgery, and vice versa.
How about symmetrical unreconstructed breasts? I'm surprised Rabin doesn't consider this possibility, because the article she wrote last year shows women who are critical of the pressure to reconstruct:
For years, medical professionals have embraced the idea that breast restoration is an integral part of cancer treatment.... In promoting the surgery, doctors cite studies that suggest breast reconstruction improves a woman’s quality of life after cancer. But some women say that doctors focus too much on physical appearance, and not enough on the toll prolonged reconstructive procedures take on their bodies and their psyches. Up to one-third of women who undergo reconstruction experience complications. A systematic review of 28 studies found that women who went without reconstruction fared no worse, and sometimes did better, in terms of body image, quality of life and sexual outcomes.


David said...

To each her own.

traditionalguy said...

I knew one young and attractive single lady in her early 20s who followed the Medical Professions leading from a test showing she had a genetic risk of breast cancer; and she had both of her breasts removed as a precaution.

Many of us wanted to tell her not to do that, but no one felt they had a right to say that to her. After all she was not killing a baby inside of her body, she was just killing her own body, preemptively.

Etienne said...

Breast reconstruction is a horrendous affair.

Basically they take a flap of skin shaped like a football across your tummy, and remove all the blood vessels except one, and then they turn and stuff the flap under your chest skin into the pocket where the breast was removed. They also put a silicon implant in to provide shape.

This flap is then stitched-in, and at a later date if it heals properly, they give it a tattoo to simulate the areola.

Meanwhile you have a tummy tuck scar that looks Frankenstein, and you can actually feel the damage as you twist around, or bend over.

You can't just do an implant alone, because the breast has a huge hole in it where they have to remove the nipple, and areola, and about a half-inch of skin in a circle.

I can see where someone would for-go the reconstruction, as the chemo will probably kill you anyway.

If you get any kind of cancer, the best thing to do is move everything to a Trust Fund, and buy a 38 pistol.

exiledonmainstreet said...

Did this trend start with Angelina Jolie, who had both breasts removed since she is genetically at high risk for breast cancer?

Birkel said...

The predictive value of the genetic tests does not, I gather, indicate these decisions are wise. But risk aversion varies and it seems an intensely personal decision.

David Baker said...

If there's a fat joke in here, I fail to see it.

Inga said...
This comment has been removed by the author.
3rdGradePB_GoodPerson said...

So, Althouse's theory that symmetry-aesthetics may be a motivator would mean that women in different areas have formed different cultural feelings re such, hence the regional differences re making the elective double mastectomy decision.

OTOH, even though Althouse ignores it, the piece includes an actual explanation that it says seems to be supported by studies. I.e., docs giving good solid info to patients. And the piece points out that there's a financial incentive for docs to withhold imparting the fullest, most clear knowledge re this decision. There may not be the mystery that Althouse is looking for.

Inga said...

What a choice. If one is tested and has the genetics that might show a very high possibility of cancer, as in some ovarian cancers, the question is do the preemptive surgery instead of taking chances of actually getting cancer? Have both breasts removed to avoid cancer in the 2nd breast? I might do it if I had young children that need their mother for years to come yet. As far as asthetics, I don't think I could remove the healthy breast for that reason. Reconstructive surgery can be done on just one side, I assume.

traditionalguy said...

Birkel reacts the way we did: It's an intensely personal decision.

But so are eating disorders that kill people to prove their eating or starving is an intensely personal decision.

I also see it as a mental illness's symptom of a compulsive need to feel in charge of something in life.

But so long as the eminent Medical guys are getting rich off of "treating" them, we will have to watch them self destruct.

Ignorance is Bliss said...

traditionalguy said...

But so long as the eminent Medical guys are getting rich of "treating" them...

traditionalguy turned into President Obama so slowly that I hardly noticed...

Laslo Spatula said...

First He Cries

Dr. Jensen: Mr. and Mrs. Anderson, I'm afraid that... the biopsy came out... positive.

Irene: Then, uh -- you'll have to perform a mastectomy?

Dr. Jensen: That's right.

Larry: You mean, cut off her breast?

Dr. Jensen: I'm afraid so.

Larry: [ looking up to the heavens ] Why me..? GOD!! Why ME..?!

[ title appears over freeze-frame ]

Announcer: "First He Cries". [ over SCROLL ] "The following docu-drama deals with a senstive social issue: mastectomy and its psychological effects on the men who must endure the anguish of living with "half a woman".

From Wiki:

"First, You Cry is a 1978 American made-for-television biographical drama film starring Mary Tyler Moore, Anthony Perkins, Jennifer Warren, Richard Dysart and Don Johnson, directed by George Schaefer. It is based on the 1976 autobiography First, You Cry written by NBC News correspondent Betty Rollin in which she recalls her battle with breast cancer."

"The film was parodied on the November 17, 1979 episode of Saturday Night Live hosted by Bea Arthur, in a sketch titled "First He Cries". In the sketch, a husband (played by Bill Murray) is distraught over his wife's (played by Gilda Radner) mastectomy. The sketch was controversial and received over 200 calls and 300 letters of complaint. Betty Rollin herself wrote a letter in support of the sketch."

Bill Murray quote from the time regarding this sketch: "Do you know what it's like to go out there and play something that's going to make people hate you?"

I am Laslo.

Etienne said...

exiledonmainstreet said...Did this trend start with Angelina Jolie, who had both breasts removed since she is genetically at high risk for breast cancer?

I don't think so. I had heard of the genetic test a few years before she chose that route. I believe it was becoming popular before, but no big names.

Michael K said...

Basically they take a flap of skin shaped like a football across your tummy,

This is not true.

First, when I was still in practice, California passed a law, promoted of course by Democrats, that the surgeon HAD to offer reconstruction to all mastectomy patients.

Second all the reconstructions I did (Maybe 500) consisted of the placement of an expander under the muscle, which would be inflated with saline after healing took place. It was inflated over a month or two until; a pocket the right size had been created. That was painless. Then the plastic surgeon would go back through a small incision and remove the inflation and replace it with a silicone implant, or when the hysteria was at its peak, one filled with saline or peanut oil.

The few cases of skin flap reconstruction I saw were done later and were done for a "tummy tuck" not just reconstruction.

Bilateral mastectomies were usually done in cases where women had had multiple biopsies for suspicious mammograms or high risk conditions where bilateral cancer (which is about 10% in all cases) was an issue. There are types of breast cancer that have higher risk of contralateral primaries.

Laslo Spatula said...

"Did this trend start with Angelina Jolie..."

The good thing is that Jolie had a lot of film evidence of her naked breasts before they were gone.

Historical Significance.

Other Hollywood Starlets should use this as a wake-up call.

I am Laslo.

MadisonMan said...

I wonder how I'd advise my daughter if Breast Cancer were a family trait. Vigilance and plenty of tests, yes. Surgery? No, I don't think so. I'm glad it's hypothetical.

One of my oldest friends -- whose Mom and Grandmother both died early of Breast Cancer or ovarian cancer -- did, when she was diagnosed with the Family Curse, have both removed. And ovaries too. She's in the medical profession, and made a pretty well-informed choice.

Having breasts removed because of *increased risk* -- not because of actual harm -- is a product of not understanding statistics.

mockturtle said...

I can see not wanting to walk with a list to one side.

MadisonMan said...

First He Cries

Written by Senator Al Franken.

Michael K said...

"Vigilance and plenty of tests, yes. Surgery? No, I don't think so. I'm glad it's hypothetical."

Not always. My travel agent was a patient for years. She had lumpy breasts and had had several biopsies for suspicious mammograms.
At the last biopsy, the pathologists said she has "busy breasts" which means they were more active than appropriate for her post menopausal condition. He was afraid she would develop a cancer and, because she had such lumpy breasts, there would be delay in making the diagnosis. We talked about it and she had bilateral mastectomies and implants.

Kate said...

My high school BFF's mother was a double mastectomy survivor. She had no reconstruction; she wore a bra that gave her a bosom. Her husband, my friend's stepfather, was an abusive monster, but the mother wouldn't leave him because he accepted her chest. She didn't know if she could ever find a man again who would love her.

Or, at least that's how my friend explained to me why her mother wouldn't walk away from the man who was molesting his stepdaughter.

Dude1394 said...

Very androgynous. I do wonder however about reconstructing to pretty flat chested? But to each their own.

Rosa Marie Yoder said...

mockturtle said...I can see not wanting to walk with a list to one side.

Indeed. The prosthetic that they gave me to put in the masectomy bra weighed a ton! I have since found better alternatives that don't give me back pain.

Obviously, I did not choose reconstruction and have no regrets. And with an Onco DX score of 2, the chances of having the other breast removed preemptivly were zero for me. Do not fear the monster; it can be defeated!

tim in vermont said...

Of course men regularly have their sex life terminated due to cancer of the prostate, and nobody writes elegiac articles to their loss, or that of their wives. That's because of the patriarchy!

Chuck said...

They are like Martinis; one's not enough and three's too many.

tim in vermont said...

I wonder how many people who take the position that "dick pills" shouldn't be covered also believe that reconstructive surgery shouldn't be covered.

Oh yeah, and Chuck, that's not funny!(tm)

Ann Althouse said...

"Did this trend start with Angelina Jolie, who had both breasts removed since she is genetically at high risk for breast cancer?"

No. Read the article, which is about women who actually have breast cancer, but only in one breast. Women with the genetic marker are advised to get both breasts removed when this happens. The question is why more and more women, especially younger women, are choosing to get the noncancerous breast removed when they DON'T have that genetic marker.

The NYT was inferring that they were unduly phobic about cancer, because these were not women who getting MORE reconstructive surgery. It notes that concern for symmetry might make a person who's getting reconstruction want both breasts to look the same and want 2 reconstructed breasts.

I'm just saying that someone who is NOT getting reconstruction might also care about symmetry. I could see feeling that way.

mockturtle said...

I'm just saying that someone who is NOT getting reconstruction might also care about symmetry. I could see feeling that way.

Makes sense to me, too. What good is one breast unless you need to breast-feed a baby. And I'm sure that would be contraindicated for medical reasons. OTOH, I've not been in a situation to have to make that decision so I wouldn't judge. I should think men probably cheer when their S.O. gets a hysterectomy but a breast removal, not so much. After all, it's all about them.