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The Cost Of Peace Of Mind: A Case Of Unneeded Bilateral Mastectomy

Fri, 01/10/2014 - 10:51am
Miranda Fielding, M.D.

I don’t have much in the way of eyebrows.  They were victims of too much plucking back in the 1960’s and when you do that, sometimes they don’t grow back.  There’s a very nice woman in Solana Beach who shapes and darkens what I have left, infrequently, when I bother to think about it which isn’t very often.

I was in there about a year ago when she told me, “I won’t be at work for the next six weeks or so — I’m having some surgery.”

Never shy when it comes to these issues, I asked, “What kind of surgery?”

She said, a little too casually, “I’m having double mastectomies and latissimus flap reconstructions.”

I said, “Why are you doing that?”

She said, “Because I was diagnosed with ductal carcinoma in situ on the left, and I just want them both off.”

Ductal carcinoma in situ is what we call stage zero breast cancer — non life-threatening, but it does need to be treated because in some cases it can progress to invasive breast cancer.  Treatment options range from excision only, to excision plus radiation, to simple mastectomy for more extensive cases.  In no case, unless the patient carries the breast cancer gene, BRCA 1 or 2, as Angelina Jolie did, is bilateral mastectomy the recommended treatment.

Again, I said to this nice 40-year-old woman with no family history of breast cancer, “Did you at least see a radiation oncologist for an opinion?  This is what I do for a living, you know.”

She said, “No, I did not.  My surgeon drew me pictures of the procedures, and he said I’d be back at work within a few weeks. This is what I want.  I have a 6-year-old son.  I do not want to die of breast cancer.”

Her mind was made up.  In situations like this, I may offer an unsolicited opinion, but here my opinion was clearly not wanted.  This was the right choice for her.  It’s what she needed for “peace of mind,” and I was not going to stand in her way.  She had her bilateral mastectomies, and her reconstructions, and true to her surgeon’s word, she was back at work within six weeks.  She was very pleased with, and relieved by her outcome.

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