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Prophylactic Mastectomy - Prevention or Barbarism?

Hexmage-PAHexmage-PA Registered User regular
edited November 2008 in Debate and/or Discourse
Last month was Breast Cancer Awareness Month, and surprisingly all the "awareness" made me aware of something I didn't know existed: Prophylactic mastectomy (that is, breast removal to prevent developing breast cancer). Of course I had known about mastectomies before, but I never knew that some women actually choose to have the procedure done when they don't have breast cancer.

From what I understand, prophylactic mastectomy reduces the risk of developing breast cancer in high-risk women by 90%, and aside from body issues and loss of sensitivity there are no serious risks to having the surgery. It's a low-risk surgery that greatly reduces the likelihood of developing a common and deadly disease.

I was reluctant to post about this here at first because I didn't think anyone would actually contribute, but I'm curious: Is there a good reason not to undergo prophylactic mastectomy?

Hexmage-PA on

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    durandal4532durandal4532 Registered User regular
    edited November 2008
    Presumably if you want to keep your breasts it would be a good plan not to have this procedure done.

    If you're at a very high risk for cancer, I can see why you'd consider it. I wonder if anyone's done a prophylactic testicle removal.

    durandal4532 on
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    QuidQuid Definitely not a banana Registered User regular
    edited November 2008
    Hexmage-PA wrote: »
    Is there a good reason not to undergo prophylactic mastectomy?
    Wanting to keep your breasts. Now, obviously, this isn't perfectly logical rationale, but there are plenty of men out there that'd turn away removing a single high risk testicle if there was still a chance of it being fine.

    Quid on
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    radroadkillradroadkill MDRegistered User regular
    edited November 2008
    I don't think barbarism is a good word to have in the title; women are choosing to have this procedure done, not being forced.

    If it's not being forced on you, I don't see how it can be barbaric.

    Personally, if I was at risk, I probably wouldn't do this because... well, I likehving my real ones. But if other women feel it's the best choice, then more power to them. I can see why they would consider it.

    radroadkill on
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    ThanatosThanatos Registered User regular
    edited November 2008
    If you're at a very high risk for cancer, I can see why you'd consider it. I wonder if anyone's done a prophylactic testicle removal.
    Breasts are a bunch of miscellaneous tissue and fat. Testicles are an important part of the endocrine and reproductive systems. That would fuck with your hormones something awful, not to mention making it way, way more difficult to have sex.

    It's not really analogous. And I'm not trying to make it seem like breast removal is "no big deal," because it is a huge fucking deal, just not on the same level that testicle removal is.

    Thanatos on
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    tbloxhamtbloxham Registered User regular
    edited November 2008
    I'm fairly confident that you can't breast feed a baby after a Masectomy, which I guess would upset some people. It also is a fairly radical surgery, and I imagine relatively expensive espescially if you follow it up with reconstruction by an expert cosmetic surgeon.

    tbloxham on
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    joshua1joshua1 Registered User regular
    edited November 2008
    Well, women in families with hereditary BRCA1/2 mutations usually develop cancer at around age 30 but can can be as early as 25 and there have been cases reported even earlier than that. The biggest benefit of a preventative mastectomy is the fact that breast tumors are metatstatic as shit due the the large ample venous supply and the fact that during levels of increased estrogen, are hot beds of proliferative tissue. And thats in healthy women!

    The sadder thing however, is that these same women have insane chances of developing ovarian cancer too. :(

    joshua1 on
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    Wonder_HippieWonder_Hippie __BANNED USERS regular
    edited November 2008
    I know a woman that had this procedure done and then had reconstructive surgery. She has fantastic breasts now, but it was an ordeal, and one that, were it not for getting the short end of the genetic stick, she wouldn't have had to go through otherwise.

    Her insurance did cover it, however, since her family had such a long history of breast cancer. I always wanted to probe and ask if her insurance pushed it on her in any way, but I wasn't that close to her.

    Wonder_Hippie on
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    The CatThe Cat Registered User, ClubPA regular
    edited November 2008
    tbloxham wrote: »
    I'm fairly confident that you can't breast feed a baby after a Masectomy,
    laughing so hard

    d'you think?
    which I guess would upset some people. It also is a fairly radical surgery, and I imagine relatively expensive espescially if you follow it up with reconstruction by an expert cosmetic surgeon.
    The reconstruction's actually covered by insurance in a lot of places, but I'm not sure whether it would be in a voluntary case.

    All that aside, what's key is that its a voluntary surgery undertaken by a small group of women, most of whom have lost a number of family members (most commonly sisters and mothers) to breast cancer. Genetic screening is often involved AFAIK to make sure there was a genetic connection and not just freak unfortunate cancer developments in the family.

    I'm pretty adamant that this shouldn't be controversial: people are consumers of medical services and have the right to request non-essential procedures from their doctors (see plastic surgery, hysterectomy, tonsil/adenoid removal etc) so long as that doesn't interfere with other people's access to more immediately important procedures. And this is hardly a vanity thing, or even something that heads off minor recurrent infections.

    I can't help but think this is only remotely controversial because of the 'boobies are pretty' factor.

    The Cat on
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    joshua1joshua1 Registered User regular
    edited November 2008
    This insurance thing is what all the lecturers getting at in subtle hints. For most of the time they are like 'Go Science" and "sequencing everyones genome would be rad" and then they sorta slip in the fact that if gene screening becomes accepted and widespread, where will it stop? I know you yanks have company funded healthcare (a weird concept to me) and that is paid for by insurance (well, the companies insurance I guess) and will you getting the sharp end of the genetic grab-bag prevent you from being covered or even employed? This sorta thing could happen in the next few years as the costs and speeds of sequencing improve all the time. Its like 300 or so dollars now, (it might even be cheaper) for one individual and if Single Molecule Realtime PCR takes off, it will be down to 10s of dollars. I very much doubt an insurer will let you claim for a genetic condition if you haven't told them of it and payed the appropriate premiums.

    joshua1 on
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    KageraKagera Imitating the worst people. Since 2004Registered User regular
    edited November 2008
    Their body, their choice and all that.

    Kagera on
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    electricitylikesmeelectricitylikesme Registered User regular
    edited November 2008
    I didn't know this existed, but it does make sense. Now I am more informed. A+ thread, would click again.

    electricitylikesme on
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    tbloxhamtbloxham Registered User regular
    edited November 2008
    The Cat wrote: »
    tbloxham wrote: »
    I'm fairly confident that you can't breast feed a baby after a Masectomy,
    laughing so hard

    d'you think?
    which I guess would upset some people. It also is a fairly radical surgery, and I imagine relatively expensive espescially if you follow it up with reconstruction by an expert cosmetic surgeon.
    The reconstruction's actually covered by insurance in a lot of places, but I'm not sure whether it would be in a voluntary case.

    All that aside, what's key is that its a voluntary surgery undertaken by a small group of women, most of whom have lost a number of family members (most commonly sisters and mothers) to breast cancer. Genetic screening is often involved AFAIK to make sure there was a genetic connection and not just freak unfortunate cancer developments in the family.

    I'm pretty adamant that this shouldn't be controversial: people are consumers of medical services and have the right to request non-essential procedures from their doctors (see plastic surgery, hysterectomy, tonsil/adenoid removal etc) so long as that doesn't interfere with other people's access to more immediately important procedures. And this is hardly a vanity thing, or even something that heads off minor recurrent infections.

    I can't help but think this is only remotely controversial because of the 'boobies are pretty' factor.

    He asked for a reason beyond "breasts are nice, men like to look at them, women like to have them to look like how they think women are supposed to" and the only real reason is that a voluntary operation will be expensive and that breast feeding is fairly important to many mothers, and possibly better for the baby. I don't see quite why you need to jump down my throat about it.

    I said "I'm fairly confident" since all the articles I found said you couldn't however I didn't want to say for sure becuase stating facts like that usually leads to someone saying "Hey, you fool, look at this operation to do X"

    tbloxham on
    "That is cool" - Abraham Lincoln
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    DetharinDetharin Registered User regular
    edited November 2008
    It is a woman's body. What say do I have in telling her what to do with it?

    Detharin on
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    The CatThe Cat Registered User, ClubPA regular
    edited November 2008
    tbloxham wrote: »
    He asked for a reason beyond "breasts are nice, men like to look at them, women like to have them to look like how they think women are supposed to" and the only real reason is that a voluntary operation will be expensive and that breast feeding is fairly important to many mothers, and possibly better for the baby. I don't see quite why you need to jump down my throat about it.

    I said "I'm fairly confident" since all the articles I found said you couldn't however I didn't want to say for sure becuase stating facts like that usually leads to someone saying "Hey, you fool, look at this operation to do X"
    Jumping down your throat? Come on. Removing the glands that produce milk means you can't breastfeed. Its funny that you said that. Funny. And there's no reason not to do it if you're at significant risk of losing your life. What other people think your chest should look like can go fucking jump.

    The Cat on
    tmsig.jpg
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    tbloxhamtbloxham Registered User regular
    edited November 2008
    The Cat wrote: »
    tbloxham wrote: »
    He asked for a reason beyond "breasts are nice, men like to look at them, women like to have them to look like how they think women are supposed to" and the only real reason is that a voluntary operation will be expensive and that breast feeding is fairly important to many mothers, and possibly better for the baby. I don't see quite why you need to jump down my throat about it.

    I said "I'm fairly confident" since all the articles I found said you couldn't however I didn't want to say for sure becuase stating facts like that usually leads to someone saying "Hey, you fool, look at this operation to do X"
    Jumping down your throat? Come on. Removing the glands that produce milk means you can't breastfeed. Its funny that you said that. Funny. And there's no reason not to do it if you're at significant risk of losing your life. What other people think your chest should look like can go fucking jump.

    Other than the inability to breastfeed, and some people don't like to chop of bits of themselves, even if they are dangerous. I mean, perhaps some women worry about what they think about their chest and how they look, not just what other people think.

    edit - Just to be clear, I don't think theres anything wrong with this sort of operation, and women with very high risk factors could well consider it however its certainly not a course of action I'd recommend being used too often!

    tbloxham on
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    The CatThe Cat Registered User, ClubPA regular
    edited November 2008
    A) where do you think that worry comes from
    b) people who don't want to chop bits off themselves don't have to

    what are you even arguing? because my central thesis in here is 'I don't care, and you shouldn't either', and I fail to see what's objectionable about that.

    The Cat on
    tmsig.jpg
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    DaedalusDaedalus Registered User regular
    edited November 2008
    joshua1 wrote: »
    This insurance thing is what all the lecturers getting at in subtle hints. For most of the time they are like 'Go Science" and "sequencing everyones genome would be rad" and then they sorta slip in the fact that if gene screening becomes accepted and widespread, where will it stop? I know you yanks have company funded healthcare (a weird concept to me) and that is paid for by insurance (well, the companies insurance I guess) and will you getting the sharp end of the genetic grab-bag prevent you from being covered or even employed? This sorta thing could happen in the next few years as the costs and speeds of sequencing improve all the time. Its like 300 or so dollars now, (it might even be cheaper) for one individual and if Single Molecule Realtime PCR takes off, it will be down to 10s of dollars. I very much doubt an insurer will let you claim for a genetic condition if you haven't told them of it and payed the appropriate premiums.

    Which is why we need to fix our health care system really fucking fast, but I'm not sure if that's the topic.

    but then, I'm not sure what the topic is, or what there is to debate.

    Daedalus on
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    ElJeffeElJeffe Moderator, ClubPA mod
    edited November 2008
    The Cat wrote: »
    A) where do you think that worry comes from
    b) people who don't want to chop bits off themselves don't have to

    what are you even arguing? because my central thesis in here is 'I don't care, and you shouldn't either', and I fail to see what's objectionable about that.

    I think the possible issue was, "Hey, here's this major elective surgery being performed by people who aren't sick but want to avoid sickness. Is it a good idea or are they being majorly paranoid?" Which is, you know, a legitimate question for those not familiar with the actual risks associated with breast cancer (like the OP and me and probably a bunch of others). It's not just "OH NOES I LOVES ME SOME BOOBIES!"

    I mean, there's a lot of alarmism in our health care industry. The question isn't exactly out of left field.

    ElJeffe on
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    an_altan_alt Registered User regular
    edited November 2008
    What does "at high risk" mean when it comes to breast cancer? Is it closer to a 0.02% chance or a 65% chance?

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    DmanDman Registered User regular
    edited November 2008
    ElJeffe wrote: »
    The Cat wrote: »
    A) where do you think that worry comes from
    b) people who don't want to chop bits off themselves don't have to

    what are you even arguing? because my central thesis in here is 'I don't care, and you shouldn't either', and I fail to see what's objectionable about that.

    I think the possible issue was, "Hey, here's this major elective surgery being performed by people who aren't sick but want to avoid sickness. Is it a good idea or are they being majorly paranoid?" Which is, you know, a legitimate question for those not familiar with the actual risks associated with breast cancer (like the OP and me and probably a bunch of others). It's not just "OH NOES I LOVES ME SOME BOOBIES!"

    I mean, there's a lot of alarmism in our health care industry. The question isn't exactly out of left field.

    I think if you have the "high risk" gene and your mother got breast cancer the risk is more like 65% that sooner or later you will get it, maybe at 25, maybe at 75, but its in the cards for you so to speak.

    I think these women are justified in getting a preventative mastectomy. I wouldn't push it on anyone but I don't object either. Personally aside from the OMG boobies arguement I would rather my children were mostly breast fed rather then purely formula fed, it's not a deal breaker I just wouldn't want a woman who was thinking about having children to rush into this kind of surgery without considering that.

    If a woman was going to get this surgery who didn't have the gene that puts you at high risk for breast cancer then I might say she's being paranoid.

    Dman on
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    NerissaNerissa Registered User regular
    edited November 2008
    Dman wrote: »
    ElJeffe wrote: »
    The Cat wrote: »
    A) where do you think that worry comes from
    b) people who don't want to chop bits off themselves don't have to

    what are you even arguing? because my central thesis in here is 'I don't care, and you shouldn't either', and I fail to see what's objectionable about that.

    I think the possible issue was, "Hey, here's this major elective surgery being performed by people who aren't sick but want to avoid sickness. Is it a good idea or are they being majorly paranoid?" Which is, you know, a legitimate question for those not familiar with the actual risks associated with breast cancer (like the OP and me and probably a bunch of others). It's not just "OH NOES I LOVES ME SOME BOOBIES!"

    I mean, there's a lot of alarmism in our health care industry. The question isn't exactly out of left field.

    I think if you have the "high risk" gene and your mother got breast cancer the risk is more like 65% that sooner or later you will get it, maybe at 25, maybe at 75, but its in the cards for you so to speak.

    I think these women are justified in getting a preventative mastectomy. I wouldn't push it on anyone but I don't object either. Personally aside from the OMG boobies arguement I would rather my children were mostly breast fed rather then purely formula fed, it's not a deal breaker I just wouldn't want a woman who was thinking about having children to rush into this kind of surgery without considering that.

    If a woman was going to get this surgery who didn't have the gene that puts you at high risk for breast cancer then I might say she's being paranoid.

    I *believe* that the cancer risks go up as you age, so many women who have the gene opt to wait until they've had their kids to get the surgery. (IIRC, the story I heard on NPR said something about risks being higher after age 40, by which time most women who are going to have kids have done so.)

    Nerissa on
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    HamHamJHamHamJ Registered User regular
    edited November 2008
    What's the benefit of doing it preventivly compared to once an actual cancer develops exactly?

    HamHamJ on
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    ElJeffeElJeffe Moderator, ClubPA mod
    edited November 2008
    HamHamJ wrote: »
    What's the benefit of doing it preventivly compared to once an actual cancer develops exactly?

    You're less likely to get cancer of the boob if you don't have boobs?

    ElJeffe on
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    KageraKagera Imitating the worst people. Since 2004Registered User regular
    edited November 2008
    ElJeffe wrote: »
    HamHamJ wrote: »
    What's the benefit of doing it preventivly compared to once an actual cancer develops exactly?

    You're less likely to get cancer of the boob if you don't have boobs?

    Also without the boob cancer you won't have to worry about the boob cancer spreading out of your boobs and into your brains!!!!

    Kagera on
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    NintoNinto Registered User regular
    edited November 2008
    Prevention.

    Ninto on
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    radroadkillradroadkill MDRegistered User regular
    edited November 2008
    I'm with The Cat. I don't see anyting to argue or object to with this. If owmen want to do it, fine. They're not being forced. Who cares? They can do what they want.

    radroadkill on
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    HamHamJHamHamJ Registered User regular
    edited November 2008
    Kagera wrote: »
    ElJeffe wrote: »
    HamHamJ wrote: »
    What's the benefit of doing it preventivly compared to once an actual cancer develops exactly?

    You're less likely to get cancer of the boob if you don't have boobs?

    Also without the boob cancer you won't have to worry about the boob cancer spreading out of your boobs and into your brains!!!!

    1) No duh ElJeffe, but if you are going to use the same procedure to prevent it as to deal with it once you have it, then waiting to see if you actually get it makes some sense.

    2) If you are taking the appropriate steps to make sure you catch it pretty earlier should you get it, isn't the chance of it spreading to the rest of the body pretty low?

    HamHamJ on
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    NintoNinto Registered User regular
    edited November 2008
    HamHamJ wrote: »
    Kagera wrote: »
    ElJeffe wrote: »
    HamHamJ wrote: »
    What's the benefit of doing it preventivly compared to once an actual cancer develops exactly?

    You're less likely to get cancer of the boob if you don't have boobs?

    Also without the boob cancer you won't have to worry about the boob cancer spreading out of your boobs and into your brains!!!!

    1) No duh ElJeffe, but if you are going to use the same procedure to prevent it as to deal with it once you have it, then waiting to see if you actually get it makes some sense.

    2) If you are taking the appropriate steps to make sure you catch it pretty earlier should you get it, isn't the chance of it spreading to the rest of the body pretty low?

    1) Depends on 2.

    2) Depends on where the cancer is. Breast cancer is particularly difficult to deal with because the tissue that's at risk is web-like, surrounded by fatty tissue. It doesn't always manifest early on as an easily detectable lump, so early screening for high risk patients involves frequent mammograms, medical attention, tests etc. Cancer, by definition, will spread, because that's what cancer does.

    Even though this is technically elective, with high risk women it should be covered by insurance or whatever health plan is covering costs because the cost of the procedure is probably much much less than all the repeated screening and testing and subsequent procedures to deal with whatever tumors are likely to form.

    Ninto on
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    DerLustigeBosniakDerLustigeBosniak Registered User regular
    edited November 2008
    The issue of body image isn't as serious as others are making it out to be if that person is comfortable with getting fake breasts in order to compensate. If she even cares, that's another thing. Then again everyone is different and certain people might not be comforted by having fake breasts in order to make up for the removal of the real breasts.

    What the fuck am I even trying to say? Jesus.

    DerLustigeBosniak on
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    DmanDman Registered User regular
    edited November 2008
    I <3 fake boobs

    I think thats what you were trying to say.

    Dman on
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    DerLustigeBosniakDerLustigeBosniak Registered User regular
    edited November 2008
    Dman wrote: »
    I <3 fake boobs & real boobs 2

    I think thats what you were trying to say.

    Fixed it up a bit.

    DerLustigeBosniak on
    sig-3.jpg
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    HamHamJHamHamJ Registered User regular
    edited November 2008
    Ninto wrote: »
    HamHamJ wrote: »
    Kagera wrote: »
    ElJeffe wrote: »
    HamHamJ wrote: »
    What's the benefit of doing it preventivly compared to once an actual cancer develops exactly?

    You're less likely to get cancer of the boob if you don't have boobs?

    Also without the boob cancer you won't have to worry about the boob cancer spreading out of your boobs and into your brains!!!!

    1) No duh ElJeffe, but if you are going to use the same procedure to prevent it as to deal with it once you have it, then waiting to see if you actually get it makes some sense.

    2) If you are taking the appropriate steps to make sure you catch it pretty earlier should you get it, isn't the chance of it spreading to the rest of the body pretty low?

    1) Depends on 2.

    2) Depends on where the cancer is. Breast cancer is particularly difficult to deal with because the tissue that's at risk is web-like, surrounded by fatty tissue. It doesn't always manifest early on as an easily detectable lump, so early screening for high risk patients involves frequent mammograms, medical attention, tests etc. Cancer, by definition, will spread, because that's what cancer does.

    Even though this is technically elective, with high risk women it should be covered by insurance or whatever health plan is covering costs because the cost of the procedure is probably much much less than all the repeated screening and testing and subsequent procedures to deal with whatever tumors are likely to form.

    That makes sense.

    HamHamJ on
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    NatanekoNataneko Registered User regular
    edited November 2008
    I can't say it's wrong to do preventive mastectomy, as long as it comes down to the woman deciding she wants to do it, and not let's say an insurance company telling someone to do it because preventing is easier than curing. But then I don't know if it's plausible to think it would come to that.

    and now anecdote time! I work at a clothing store, and once had a woman in her 60's who had both breast removed the month before. She had a tumor in one and basically harrassed her doctor cause he didn't want to remove the non-cancerous breast too. She said she felt really good now, that she hated her breast and wanted them gone for a long time. For her, the preventive surgery was a good thing.

    Someone mentionned the issue of body image. maybe it seems unimportant to some, because after all, they are just boobs. Of course cancer does a lot more damage than bad body image issues, but it still does. I know that my breast are a big part of how I define myself. I don't think saving me from an hypothetical cancer would be worth this big part of myself (as stupid as it may sound)

    Nataneko on
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