Topic

Bilateral Mastectomies

Description

In 2005 and 2006 We have been consulted more than 10 times concerning the advisability of bilateral mastectomies for DCIS diagnosed in one breast.

First, understand that this decision is for life, and may be being undertaken in an emotional turmoil involving not only the patient, but concerned family, friends and caregivers. The involved parties may know that in later years the patient may come to understand that the threat to survival as well as clinically serious disease in the contralateral breast are almost nil. This is particularly true if viewed in terms of the next few years. We find most alarming that there are some caregivers that encourage this approach of extensive surgery using such phrases as, "if you were my wife, or if you were me (female surgeon) I would have both breasts removed next week." Amazingly, if the diagnosis is later found to be in error, the surgeon encouraging the radical therapeutic approach may not be legally culpable. This is because a pathologist may have made the diagnosis and the radical approach of removing both breasts is "within the standart of care" for DCIS

Suggested Course of Action

Get a second clinical as well as pathology opinion when radical approaches are encouraged. Also, recall that the 2nd mastectomy is a preventive operation for the possible eventuality of later disease there, that usually does not happen.