Subcutaneous Mastectomy in the Treatment of the High-Risk Female—Is Emotionalism Obscuring the Facts?

Abstract

The much-debated procedure of subcutaneous mastectomy has demonstrated the ability to turn up clinically or radiogrophically undetected carcinoma or precancerous lesions in about 21% of patients undergoing the procedure when adequate screening is performed. This detection rate appears superior to that for close follow-up or radiographic screening procedures in detecting preinvasive or early invasive carcinoma. The main objection—that residual breast tissue remains which is at high risk for subsequent malignant degeneration—is valid, but to date the reported incidence of 0.5% may mean the operation is a worthwhile means of prophylaxis for selected patients whose risk of developing carcinoma is in the range of 20 to 30%. Although the procedure is not a totally sure means of prophylaxis or a cosmetically pleasing operation, its acceptance has been widespread by women in high-risk categories. The lack of acceptance by the surgical community before statistically significant followup evaluations can prove or disprove its safety may derive from Halstedian tradition in evaluating breast procedures. For now, it appears the most useful course is to select patients stringently for the procedure and to follow them individually and as a group nationally. Only such data will show whether subcutaneous mastectomy should continue to be used as a compromise alternative in averting breast cancer and lowering its mortality.