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
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,
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.
- 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
- 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.