In her 17 years of helping women with breast cancer, Souzan El-Eid has seen a startling evolution in their views on mastectomy. The Comprehensive Cancer Centers breast surgeon, who received a Most Compassionate Doctor award from Patients’ Choice last year, says she and her colleagues are now doing many more prophylactic mastectomies, such as the one actress Angelina Jolie recently had, than they were 10 years ago.
First of all, define a “prophylactic mastectomy”?
It’s preventive—you’re preventing the cancer from happening. We think the breast is healthy, but we’re taking it out because the patient has a higher risk than average of developing breast cancer. If the patient already has cancer, the mastectomy is called curative.
Why the rise in these procedures?
Because of improved understanding of the disease. We’re getting better at early detection with digital mammography and MRI, and there have been advances in gene testing to identify a gene mutation that could cause cancer. Patients at high risk elect to do the surgery so they don’t have to keep worrying. There are studies that have shown a 96 percent chance of prevention with prophylactic mastectomy. Also, we have made improvements in the surgery itself.
What are some of those?
In the old days, surgeons took the breast and the muscle—a procedure called a radical mastectomy; then they started leaving the muscle behind (modified radical); and then they did more lumpectomies (removing a segment of the breast). Now, there’s a transition to bilateral mastectomy. Most prophylactic mastectomies are simple skin sparing—taking the breast (no muscle), and leaving the overlying envelope for reconstruction.