Biology in the News Explained

Does mastectomy equal selfectomy?

A lot of breast cancer literature out there encourages the option of lumpectomy + radiation over mastectomy. This is understandable, since for a long time, mastectomy was considered the only option, and may be overkill for a lot of early stage breast cancers. But the NIH’s current statement on the matter seems rather strong in the other direction:

Breast conservation treatment is an appropriate method of primary therapy for the majority of women with Stage I and II breast cancer and is preferable because it provides survival equivalent to total mastectomy and axillary dissection while preserving the breast.

Better sites for the layperson weighing the pros and cons of these options are those of the Mayo Clinic and BreastCancer.org. These pages place greater emphasis on the state of mind of the patient. All things being equal, the question really boils down to, how emotionally attached are you to your breasts?

Given that the NIH statement seems to assume the patient has the necessary general good health to withstand either major surgery or six weeks of radiation, the word “preferable” seems to jump out. Why is it assumed that “preserving the breast” is preferable?

Well, likely it is for many women. Perhaps most. But have these women ever asked themselves why? It would be interesting to know how many women are as in love their breasts as doctors seem to assume. True, once you amputate a body part, you can’t have it back. Then again, if cancer recurrs, you may end up with a mastectomy anyway, in addition to the radiation you had before.

And what is “survival equivalent” anyway? Pretty much just time until death, statistically. There is nothing in that statement to do with quality of life, which clearly can be affected negatively if cancer comes back to a body part that you really don’t need, even if you don’t happen to die from it any faster.

Even many women who choose (or have to have) mastectomies then choose to undergo another major surgery (or more) to make fake breasts. Reconstruction is major because if you use your own body tissues, you actually have to have muscle from your abdomen or buttocks transplanted to the new “breast” so it will have a decent blood supply. This assumes you aren’t already using that muscle for some other purpose, which many of us probably are. And although you may be shaped roughly as before after surgery, there is no sensation in that region anyway, so it really is just for show.

What does a woman lose when she loses the outline of her breasts? Why are breasts presumed to have deep emotional meaning to their owner apart from the feelings of those in sexual pursuit of their owner? Is their value inherently felt or imposed by society? Given the many obvious advantages of not having breasts – men get along just fine without them – one could just as easily imagine them as emotionally easy to part with as a gall bladder. For some of us at least, they certainly are. Given the rampant epidemic that is breast cancer in women, these are not trivial questions.

More on the meaning of breasts…

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2 Responses to “Does mastectomy equal selfectomy?”

  1. Mrs. Charlottesvillian says:

    For better or worse, breasts have a position in Western society not held by gall bladders. An article I read recently about cancer said that many women who survive chemo say that the most traumatic part is losing their hair. Hair and breasts are both indicia of femininity, broadly speaking (no pun intended), here and elsewhere. This obviously means very different things to different women — depending on psychic investment in their physical looks, life experiences, age, and family circumstances, among other factors.

    So, here is the thought experiment: If a young woman is diagnosed with early-stage breast cancer who is unmarried and hopes to survive this current illness and go on to someday have children (and possibly breast feed them) — and, ok, throw in that she is only orgasmic through nipple stimulation :-) — should her mere “feelings” about her breasts and what she would like to use them for in the future factor into a treatment decision?

    If ‘yes’ for her, what doctor wants to draw the line and assume that the woman sitting before him is “clearly” (based on his limited knowledge of her — he is her surgeon or oncologist, not her therapist!) — ‘done’ with her breasts.

    But, again, this points to a failure with our current medical configuration — insofar as we treat illness, not people. If doctors knew more about their patients, they might have an ability to have a more nuanced conversation with them that would lead to a better decision for the individual in these (and other) cases. (Nuanced conversation, of course, not necessarily being a highly-enough valued medical skill.)

  2. Shlog Blogger says:

    Mrs C-

    I’m assuming you think that all doctors are male as you refer to the uncaring physician in your little vignette as “he”. Now isn’t THAT interesting? Why that default?

    “we treat illness, not people” – what utter rubbish!

    You also probably believe that “illnesses don’t kill people- PEOPLE kill people”???

    Dr ShlogBlog

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