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    Outpatient Mastectomy a Viable Option for Many Women

    WebMD Health News

    March 24, 2000 (Atlanta) -- It was the summer of '96 when Carol Stacey got the news. Breast cancer. Her feelings were "absolute terror," Stacey tells WebMD. Mastectomy, or complete removal of the breast, was necessary, but her surgeon offered outpatient surgery as an option, which meant, in this case, less general anesthesia, less nausea -- and no overnight hospital stay.

    "Even then, I expected to feel terrible, like you do after most operations," says Stacey. "But when I went home, I felt great, great! That very same day. You're usually nauseous, drugged, for a couple of days. But I felt good, really good."

    Later, a few HMOs tried to make the outpatient procedure mandatory, and it was branded by some as "drive-through mastectomy." Battles were fought in state legislatures to ban the procedure. Surgeons from Johns Hopkins Medical School found themselves lobbying for patients' rights. Stacey found herself compelled to write a letter to the Baltimore Sun, a testimonial about her own very positive experience "so that women would have the option at least of having this as outpatient surgery," she tells WebMD.

    Unfortunately, in the media uproar, some very promising data got lost, William Dooley, MD, a surgical oncologist and medical director of Johns Hopkins Breast Center, tells WebMD. At Hopkins and a handful of other top cancer treatment hospitals, outpatient mastectomy was proving to be a significantly better option for some women.

    "The HMOs had found that patient outcomes [at these hospitals] were substantially better and with less risk," says Dooley, who helped lead the lobbying effort in Maryland and on Capitol Hill. "Each of these hospitals [surveyed by the HMOs] had gone about it like we had, improving quality of care, which made it possible for patients to go home early."

    "Outpatient mastectomy is both medically safe and can be a positive treatment experience if patients and families are well prepared," Dooley reported at a recent meeting at the Society of Surgical Oncology.

    He presented data on a series of mastectomies in 204 patients, average age 58, all performed between 1995 and 1997. All patients were given the option of having the procedure done on an outpatient basis -- meaning they would leave the hospital five hours after surgery.

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