Breast surgeons rock

It takes a long time for medicine to embrace new ideas and change practice accordingly. Research, too, is painstakingly slow.

Surgery is slightly different, however. Surgeons can make small adaptations to standard operative techniques, adding their own refinements to existing procedures without absolute proof that their innovations are truly beneficial. They can merge procedures in the hope of improving outcomes for their patients.

When I was a medical student my mother was diagnosed with breast cancer. It was a fraught time as my little knowledge only served to make me feel utterly unable to guide her. She opted for a total mastectomy followed by immediate reconstruction, a major undertaking but one that was curative and the right decision for her. But that decision was not based on sound medical evidence, only her own preferences and the recommendations of her brilliant surgeons.

Now a unique audit into breast cancer surgery has produced the first national figures on how patients view the outcome of mastectomy and breast reconstruction surgery and has found that these innovations and adaptations made by the surgeons on the front line have paid off.

Eighty-eight per cent of women felt they had always been treated with respect and dignity while in hospital and 90 per cent rated the care they received as excellent or very good. More than 90 per cent were very satisfied with the competence of their consultant surgeon, and 85 per cent were very satisfied with the professionalism of the team.

More importantly, these data have finally confirmed that women prefer to undergo a breast reconstruction at the same time as they have their cancerous breast removed, so they never experience the trauma of seeing themselves without a breast and the fear of feeling less feminine. Eighteen months after reconstructive surgery, 85 per cent of women reported feeling confident in a social setting most or all of the time. Women who underwent mastectomy without reconstruction reported less positive results.

Women who chose breast reconstruction at the time of their mastectomy also reported higher levels of emotional and sexual wellbeing than those who underwent mastectomy alone.

When we are supposed to be practising only evidence-based medicine it is good to have confirmation that we are indeed getting some things right.

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