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Outpatient Mastectomy a Viable Option for Many Women


"Any hospital can do this," says Dooley. Citing nausea and vomiting as the primary factors that incapacitate and distress women after the procedure, he lists some general principles: less narcotics, more local anesthesia, different sequencing of drugs, more education (before surgery to reduce anxiety), support from local home care agencies, provisions with local hotels for overnight stays (for those patients living one or more hours from the hospital).

Lawrence Gratkins, MD, a pioneer in outpatient gynecologic surgery, points out that his concern is insurance companies trying to decrease their hospital-based costs and the cost shift to the physicians office and to the patient. He tells WebMD that before we can make a national standard for outpatient mastectomy, we must provide adequate education to nurses and patients and families and community-based resources, like home health providers. He is an obstetrician-gynecologist at Christie Clinic in Champaign, Ill.

Dooley says, "You have to constantly seek to improve your quality to take a revolutionary step like this. What we found is that it holds us to a higher quality standard. We tolerate glitches less."

Calling the Johns Hopkins report "very good clinical work," Michael Torosian, MD, clinical director of breast surgery research at Fox Chase Cancer Center in Philadelphia, tells WebMD, "It's a good technique for selected patients ... young women who don't have any other medical problems and who tolerate the anesthesia well.

"It shows it's safe to do, and I believe that. Just a few years ago, we used to keep these same patients in for a week. We've gone from a week to a day to less than a day, so I know it's possible," Torosian says.

Although she agrees that mastectomy alone can easily be done on an outpatient basis, Toncred Styblo, MD, associate professor of neoplastic surgery at Emory University's Winship Cancer Institute, tells WebMD, "At Emory, almost all our mastectomy patients have immediate reconstruction [of the breast], so they're not really eligible for outpatient mastectomy." She recommends immediate reconstruction, she says, for cosmetic reasons -- the breast will look better. "It looks far better," she says.

Vital Information:

  • Women who choose to have an outpatient mastectomy, instead of staying in the hospital, report a 98% satisfaction rate with the procedure, according to a recent study.
  • These women reported feeling empowered by being able to participate in the decision making, and researchers suspect the psychological benefit contributes to positive outcomes.
  • Of the patients undergoing mastectomy, 95% chose to be outpatients, and these women experienced fewer side effects and complications, even after the surgery, compared to inpatients.
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