Jul 14, 2015 — by Dr. Joel Aronowitz
Dr. Aronowitz and Dr. Holmes respond to the latest Wall Street Journal article, "The Double Mastectomy Rebellion".
Your recent article describing women who rebel against doctors' recommendations by choosing double mastectomy unfortunately misses the revolution in mastectomy techniques driving the trend. Oncoplastic procedures such as nipple sparing mastectomy (NSM) preserve a natural appearing breast often in a one stage procedure. By applying established plastic surgery principles to cancer surgery these operations offer women an attractive alternative to traditional modified radical mastectomy with its' familiar horrifying oblique chest scar and mutilated appearance.
Solid clinical research supports the effectiveness of these surgical alternatives to modified radical mastectomy or lumpectomy and radiation. But, instead of acknowledging the valid desire of women to preserve their femininity and expanding the use of cosmetically superior oncoplastic procedures, many respected breast cancer centers have been painfully slow in adopting these procedures. The profession could take a lesson from the modern history of this ancient disease. Many significant advances in breast cancer care are arguably the direct result of rebellious women. This includes the 1950's shift from the crippling Halsted radical mastectomy to the today's standard modified radical version and in the 1970's public demand for routine screening mammography, led by a courageous Betty Ford, made early stage diagnosis common.
Todays mastectomy rebellion is driven by womens' increasingly awareness of the NSM option. Women reject the premise that effective treatment and prophylaxis of breast cancer must include life changing disfigurement and in many cases they are correct. We appreciate the attention to this significant women's health issue and call on respected sources like the WSJ to recognize that oncoplastic options are driving the mastectomy trend. The WSJ can help empower women facing difficult choices with more complete information about relevant differences between nipple sparing and skin sparing mastectomy versus the disfiguring modified radical version in future reporting.
Joel Aronowitz, M.D.
Diplomate, American Board Plastic Surgery
Fmr Chairman, Division Plastic Surgery Cedars Sinai Medical Center
Founder, Breast Preservation Foundation
Associate Clinical Professor, USC Keck School of Medicine
Los Angeles, CA
Dennis Holmes, M.D., F.A.C.S.
Breast Surgeon and Medical Director
Los Angeles Center for Women's Health
Board Member, Breast Preservation Foundation
Los Angeles, CA