Mastectomies have become much less invasive, debilitating

By Sue Vorenberg, Columbian features reporter

Published:

 
photoDr. William S. Halstead, 1922, who popularized the radical mastectomy procedure.

Breast cancer surgery has come a long way since ancient times.

As early as 5,000 years ago, the ancient Egyptians tried removing tumors with a flaming hot drill without much success.

Other civilizations tried treating tumors by cutting them from the body, but found that more often than not the tumors would simply return.

About 1,800 years ago, the Greek doctor Galen noted that removing tumors in the very early stages could sometimes cure the disease. But ancient surgeries were risky business. Procedures were done with no anesthesia, and patients often ended up suffering severe blood loss and post-surgical infections, which could be equally deadly.

Those methods remained the only options until the mid- to late 1700s, when autopsies and use of the scientific method led to better understanding of the disease.

Even then, the primary surgical option used up until the 1970s bordered on barbaric.

William Halstead, a professor of surgery at Johns Hopkins University, created a radical mastectomy procedure in the 1890s that remained the standard through the 1960s.

A surgeon removed the patient’s breasts, nodes in the armpits and both chest muscles in a single procedure to get rid of the tumor and all surrounding tissue — healthy or not — in an attempt to stop the spread of the disease.

“It was a complete removal of the breast all the way down to the bone and the ribs,” said Dr. Toni Storm-Dickerson, a breast surgical oncologist at Compass Oncology. “It was very disfiguring, very hard for the woman to move afterward.”

Similar surgeries were performed before Halstead’s procedure, but the development of antiseptic methods and anesthesia improved the survival rate in Halstead’s method, Storm-Dickerson said.

Still, “this was a horrible surgery in terms of morbidity,” Storm-Dickerson said.

Survivors could expect a deformed chest wall, voids under the armpits and collarbone, chronic pain, and swelling in the arms because the removed lymph nodes left them unable to process circulatory fluids effectively.

“They did this surgery for all comers, so you might be Stage 1 and get the same surgery as if you were Stage 4,” Storm-Dickerson said. “And in many cases, they found the survival rate wasn’t much better (than doing nothing).”

Halstead also considered amputating the shoulders at one point and dismissed the side effects of doing so, writing that they were “a matter of very little importance as compared with the life of the patient. Furthermore, these patients are old. Their average age is nearly 55 years. They are no longer very active members of society.”

Today, radical mastectomies are extremely rare. But it wasn’t until the 1970s that clinical trials proved that less extensive surgery is often equally effective for women with breast cancer.

Alternative surgeries first developed in the 1950s and 1960s removed tumors and lymph nodes from under the armpits but didn’t take the chest muscles unless the cancer had spread there.

“The result was, women had much greater use of their extremities and no lymphodema (swelling in the arms),” Storm-Dickerson said.

Mastectomies today can also preserve much of the breast envelope, and reconstructive surgery methods are greatly improved, even if the results still have some drawbacks, she said.

“The reconstructed breast is never what God gave you to start with,” Storm-Dickerson said. “They may be perkier, but you never get the full sensation back and it never feels quite the same.”