Views on Prophylactic Mast

[Cynthia]

Mary Jo,

Thank you for your kind words. I applaud you for knowing when to walk out of one doctor's office and into another's. Too often I think we forget that doctors come in many flavors, and that it is up to us to seek out one (or two or three) that works best for each of us.

I really do think that this whole topic of mastectomy v. lumpectomy has gotten wrapped up a bit in gender politics. (That came through loud and clear to me in the original Washington Post article.) I think that the mastectomy procedures of old were terribly brutal and disfiguring. I believe that some in the women's movement accused the mostly male surgeons of butchering women needlessly because men didn't respect women (or their breasts) enough to try to save them. I think that perhaps the reaction to that accusation has caused the pendulum to swing a bit too far in the other direction -- i.e., some surgeons don't want to be accused of being uncaring and insensitive, so they tend to steer women away from mastectomies (which are still major operations, but done much better than in days of old) and towards lumpectomies without pausing long enough to lay out the pros and cons of each to each patient. In doing so, I think they may be doing their patients a disservice by discarding the legitimate concerns that some patients express about going the lumpectomy route. By focusing merely on the endpoint that mastectomies and lumpectomies have equivalent overall survival statistics, I believe that these physicians are missing the nuances that make each of us who we are. Just as I wouldn't want to return to the day when brutal mastectomies were the norm, I don't like the paternalistic view that if you choose a double mastectomy, you are somehow an ignorant, hysterical ninny.

Krista, I would hope your thoughts and feelings about wanting to retain your breast(s) are treated with every bit as much respect as are the desire of others to undergo a bilateral mastectomy. Please don't think for a moment that I am being critical of those who opt for a lumpectomy over mastectomy. On the contrary, once you have all the information required to make an informed choice, I whole heartedly applaud your making the decision that is best for you.

If the answers were easy, we would all know what to do. But they aren't, so we don't.

Ok, off the soapbox now and back to work.

[Sheila]

Just a quick question on this subject...I also wanted to go the double mastectomy route...I had had 7 biopsies in the remaining breast, so it to me seemedlike a no brainer. But the insurance company denied me, refused to pay for a mastectomy on a healthy breast. Considering the price, I could not afford to pay the $25,000 out of pocket (and that was 6 years ago). Just wondering how the rest got approval from the insurance company, or do they look at things differently now?

[Cynthia]

Sheila,

I am so sorry to hear that you had that fight. I had no problem getting the insurance to approve removal of the "healthy" breast. I believe the doctor submitted the request with a recommendation that it be done based on medical necessity. (In my case, my dense breast tissue made it very hard to diagnose me on scans and they were concerned about the ability to monitor my "good" breast going forward.) Perhaps the argument that you have had to undergo 7 biopsies is enough to get over the medical necessity threshold to get approval. If this is something you really want to pursue and are turned down, I would go through the appeals process. In light of the recent court decision slamming an insurer for cutting off coverage of a breast cancer patient in the middle of her treatment, you might find a different atmosphere right now.

Best.