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From: oliver@unc.UUCP (Bill Oliver)
Newsgroups: net.med,net.women
Subject: Re: Breast Cancer Treatment.
Message-ID: <647@unc.UUCP>
Date: Sat, 20-Jul-85 23:21:40 EDT
Article-I.D.: unc.647
Posted: Sat Jul 20 23:21:40 1985
Date-Received: Sun, 21-Jul-85 17:05:20 EDT
References: <1765@aecom.UUCP> <mnetor.1271> <602@unc.UUCP> <hammer.1390>
Reply-To: oliver@unc.UUCP (Bill Oliver)
Distribution: na
Organization: CS Dept., U. of N. Carolina at Chapel Hill
Lines: 64
Xref: pepe net.med:649 net.women:3136
Summary: 

In article <hammer.1390> seifert@hammer.UUCP (Snoopy) writes:
>In article <602@unc.UUCP> oliver@unc.UUCP (Bill Oliver) writes:
>>  I suspect that younger, healthier women would
>>tend to opt for more cosmetically pleasing surgery and would 
>>bias the population.
>
>"cosmetically pleasing" ?   This is truely warped.  Someone objects
>to having entire, functional parts of their body whacked off, when
>a much less radical option is available, and you accuse them of
>only being worried about cosmetics?  I for one am grossly offended
>by this attitude.
>
>the Bavarian Beagle
>tektronix!hammer!seifert

I accuse no one of anything.  You must understand that it is you, not
I who denigrates the importance of the cosmetic results of surgery.
To have restored the elephant man to relatively normal facial
features (which, by the way, is now frequently practical), to 
restore a face following severe trauma, to preserve or restore 
the appearance of a breast through specific surgical intervention
are all cosmetic procedures.  This does not mean that they are not
important; cosmetic surgery can transform a life.

It is my experience, which while somewhat limited is not negligible,
that many women who are contemplating a mastectomy are in fact
very concerned about how they will appear in clothing, in a bathing
suit, to their lovers.  This is not a question of functionality.  The 
women are no more concerned about losing one half of their potential 
for lactation than a woman contemplating a cholecystectomy is
concerned about a decrease in her ability to store bile.  
A woman`s breasts are often important for her self-image, and
that image is more frequently associated with the appearance of
the breasts than with their function. That, by definition, is cosmetic;
it is by no means trivial.  It is possible,
in many instances, to restore much of the visual and even external
tactile appearance of a breast.  In some instances, it is feasable
to transplant the nipple and areola to a secondary site and then
re-implant it onto the restructured breast.  It is also my
experience that younger women are more concerned about the
appearance of their breasts than are older women, though 
by that I do not wish to imply that older women are not 
seriously concerned.

I further maintain that my analogy to castration is fairly apt.  Just
as women are concerned about "having entire, functioning parts of 
their body whacked off", so are young men frequently concerned
about the loss of a testis as occasionally occurs with trauma 
or malignancy. In fact, prosthetic (nonfunctioning)
prostheses are available for implantation in the case of a man
who suffers severe problems of self-image due to the loss of
one or both testes. It is also my experience that younger men
are more concerned about the loss of a testis than are older 
men, though by that I do not wish to imply that older men are
not seriously concerned.

My purpose in the statment you object to was to illustrate 
why self-choice was not an acceptable alternative to 
random assignment to treatment groups.
Perhaps my desire not to be flippant when discussing the topic
lead to a surfeit of euphemisms. If so, I apologize.  In the
future I shall be more explicit. 

Bill Oliver