My breast I could not’
tuck to boot. But here’s the rub: while many of those who make this choice believe they are doing the safest and best thing to protect themselves from death and future disease, the truth is not nearly so clear-cut.
“A lot of women ask for a double mastectomy because they think it will mean they won’t get breast cancer again, or that they won’t die of it,” says MacNeill. “And some surgeons just reach for their diary. But what they should do, is ask: why do you want a double mastectomy? What do you hope to achieve?”
And at that point, she says, women normally say, “Because I never want to get it again,” or “I don’t want to die from it,” or “I never want to have chemotherapy again.”
“And then you can have a conversation,” MacNeill says. “Because none of these ambitions can be achieved by a double mastectomy.”
Surgeons are only human. They want to concentrate on the positive, says MacNeill. The much-misunderstood reality of mastectomy, she says, is this: deciding whether a patient should or shouldn’t have one is usually not connected to the risk posed by the cancer. “It’s a technical decision, not a cancer decision.
“It may be that the cancer is so big that you can’t remove it and leave any breast intact; or it might be that the breast is very small, and getting rid of the tumour will mean removing most of [the breast]. It’s all about the volume of the cancer versus the volume of the breast.”
JAMA Surgery