Mastectomy is not always so bad

BMJ 2003; 326 doi: https://doi.org/10.1136/bmj.326.7381.166 (Published 18 January 2003) Cite this as: BMJ 2003;326:166
  1. Kate F Gould (kate.gould{at}nuth.northy.nhs.uk), consultant microbiologist
  1. Freeman Hospital, Newcastle upon Tyne NE25 8AR

    EDITOR—I was alarmed by the choice of photograph used to illustrate Gottlieb's news item on mastectomy versus lumpectomy for breast cancer.1 It portrays an elderly woman with extensive scarring of the chest and what seems to be a recent midline abdominal scar. I think most breast surgeons would agree that this is not typical of the expected appearance “several months after mastectomy.”

    Gottlieb says that mastectomy is still indicated in those patients who do not have small tumours (<2 cm). Any woman researching her condition before embarking on a course of treatment would probably be horrified by the photograph and may not agree to such surgery, even if it were in her best interest.

    I underwent a mastectomy (out of choice) for breast cancer three years ago, at the age of 41. Thanks to the skill of my surgeon, the scar on my chest is almost invisible, and I have declined a reconstruction. Not only was my tumour >2 cm, but it comprised two adjacent, but not contiguous, tumours. Even if I had opted for a lumpectomy I would have had to have a subsequent mastectomy—two operations instead of one.

    The BMJ must realise that a wide range of people outside the medical profession access the journal. The photograph was probably chosen deliberately to show mastectomy at its most disfiguring, but I wonder if it was properly thought through.


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