More on breast cancer guidelines
CMAJ 1998;158:1425
See response from: M. McGregor
I was surprised that the supplement "Clinical practice guidelines for the care and treatment of breast cancer: a Canadian consensus document" (CMAJ 1998;158[3 Suppl]:S1-83 [full text / text complet]) makes no mention of breast reconstruction and that in the accompanying booklet "Questions and answers on breast cancer: a guide for women and their physicians" (CMAJ 1998;158[3 Suppl] [full text / text complet]) such surgery is mentioned only in a negative context.
Our practice for women with breast cancer who are considering mastectomy is to mention the possibility of reconstruction at the time of the surgical consultation. When performed at the time of mastectomy, reconstructive surgery may be associated with fewer problems and better patient satisfaction than if it is performed later.
Women who have undergone breast reconstruction are highly satisfied and have an improved self-image. For most patients, the limitations of the procedure in terms of shape and sensation of the reconstructed breast are far outweighed by the positive aspects, especially the natural contour (without an external prosthesis) achieved by current surgical techniques that use the patient's own tissues.
James Mahoney, MD
Chief, Division of Plastic Surgery
Associate Professor
Department of Surgery
St. Michael's Hospital
University of Toronto
Toronto, Ont.
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