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  • Little Value from Prophylactic Mastectomy

    Posted 10/9/2013 by hhill
      I have written many times about the rising choice of prophylactic mastectomies for women who are also offered the option of lesser surgery. Note: the situation of women who carry a genetic mutation, BRCA1 or BRCA2, is obviously different. We are thinking here about women who are diagnosed with breast cancer, told by a surgeon that a lumpectomy/wide excision and radiation is an equally effective treatment, and who opt for either one or even two mastectomies. No matter what else is said, it is clear that these women believe that they are increasing their chances to stay healthy by having more surgery. Read more... Comments (0)
  • Understanding Risk and Surgical Decisions

    Posted 9/20/2013 by hhill
      This is another in my continuing series about surgical decisions. Although I will always support a woman's decisions for herself, I often feel that women do not fully understand the realities of cancer risk and the consequences of surgery. Surgeons, in general, resist removing healthy organs and usually push back, at least a bit, if a woman wants her other (non-cancer) breast removed. They may also push back a bit if a woman chooses mastectomy with lumpectomy/wide excision would be an equally sound medical decision. Read more... Comments (0)
  • Persistent Post Mastectomy Pain

    Posted 9/17/2013 by hhill
      Attention is finally being paid to the rather common problem (best guess is that one third of women post mastectomy experience it) of chronic pain after mastectomy. My personal experience of a mastectomy without reconstruction has, blessedly, not included pain although I still feel the stretch when my extend my arm fully over my head (and have felt that since the 1993 surgery) and occasionally feel brief muscle spasms, like a charley horse, in my chest. Read more... Comments (0)
  • Choosing Not to Have Reconstruction

    Posted 8/26/2013 by hhill

      One of the more difficult choices facing women who need or opt for a mastectomy (or bilateral mastectomies) is whether or not to have reconstruction. Increasingly, women prefer to have reconstruction, and it sometimes can feel as though there really is not another option. At least at our hospital, our breast surgeons tend to say something like: "I am sorry that you need a mastectomy, but you can find reconstruction at the same time." One of my ongoing campaigns is to change that sentence to: "I am sorry that you need a mastectomy. We can talk more about whether you want reconstruction and, if so, how to learn about your choices."

    Read more... Comments (1)
  • Bilateral Mastectomies and Peace of Mind

    Posted 8/7/2013 by hhill
      With only a little stretch, this could be considered a companion piece to yesterday's entry about the value of experience in parallel with the newest knowledge. The larger topic on the table is the need to address peace of mind in addition to the specific medical issues. I often suggest to women that, in making a tough decision, one factor will be considering what choice will help them sleep at night, both now and five years from now. Another perspective is identifying the worst possible outcome (and the answer to that is surprisingly variable) and then doing whatever is necessary to avoid that possibility. Read more... Comments (0)
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Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215

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