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Many Breast Cancer Patients Candidates for Outpatient Mastectomy (dateline March 27, 2000)

According to a study presented at a recent meeting of the Society of Surgical Oncology, the vast majority of women who have a mastectomy (breast removal) on an outpatient basis experience fewer side effects and are more satisfied than women who are admitted to a hospital for the procedure. Researchers cite the psychological effects of an outpatient mastectomy as one of the greatest benefits for patients. In the study, women who had outpatient mastectomies said their spirits were lifted because they felt more control over their recovery and treatment options. Mastectomy is a surgical treatment for breast cancer that involves removing the entire breast.

The study presented by William Dooley, MD, director of the Johns Hopkins Breast Center, involved 204 mastectomy patients (average age 58) between 1995 and 1997. All of the patients in the study could choose between an inpatient and outpatient procedure. Outpatients could leave the hospital approximately five hours after the surgery if there were no complications. One year after breast cancer treatment, 98% of the patients described their condition as "very good" or "excellent."

According to Dr. Dooley, most women who have mastectomies performed on an outpatient basis feel more control over their condition. In fact, the majority of outpatients experience fewer side effects and complications from surgery as well as from chemotherapy and radiation therapy after surgery, said Dr. Dooley.

An outpatient mastectomy is now an option at many hospitals, including Johns Hopkins Breast Center. When the outpatient program began in 1995 at Johns Hopkins Breast Center, only 15% of patients chose to be outpatients. Currently, 95% of patients choose to be outpatients according to Dr. Dooley. Michael Torosian, MD, clinical director of breast surgery research at Fox Chase Cancer Center in Philadelphia, Pennsylvania agrees that an outpatient mastectomy is a viable option for "selected patients." Dr. Torosian cites young patients with no other medical problems and who handle anesthesia well as good candidates for outpatient surgery.

Toncred Styblo, MD, associate professor of neoplastic surgery at Emory University’s Winship Cancer Institute, also believes mastectomies may be performed successfully on a selected outpatient basis. However, most of Emory’s mastectomy patients choose to have immediate breast reconstruction (during the same procedure as the breast is removed) and therefore are not candidates for an outpatient procedure.

Another issue facing mastectomy patients is insurance coverage. In the late 1990s, a handful of HMOs tried to make outpatient mastectomies mandatory, causing an uproar among patients and medical professionals. Though physicians are concerned about insurance companies trying to persuade patients to have outpatient mastectomies to lower hospital costs, they maintain that the procedure is medically safe and feasible for many patients.

The length of a hospital stay after mastectomy varies greatly from over a week to less than one day, depending on a patient’s condition. Healthy patients interested in outpatient mastectomies are encouraged to discuss the option with their surgeon or cancer treatment team . Medical professionals warn that outpatient mastectomies are not ideal for all patients and some hospitals do not offer the option.

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