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That's the new proposal of surgeon Bernard Palmer, who advocates "prophylactic" mastectomies (ie, mastectomies on healthy breasts) for women with a family history of breast cancer

That's the new proposal of surgeon Bernard Palmer, who advocates "prophylactic" mastectomies (ie, mastectomies on healthy breasts) for women with a family history of breast cancer.

Palmer, consultant surgeon at the Lister Hospital in Stevenage, Hertfordshire, has spent seven years perfecting an operation he calls subcutaneous mastectomy (or "subcut", as it is known in the trade), for women with breast cancer or at high risk of developing it.

With the operation, the breast tissue is removed and replaced with a silicone implant. The fat, skin and nipple are intact, with the only evidence of operation, a scar running between the nipple and the armpit.

This operation is offered as an alternative to lumpectomy, where only the cancer itself is removed, or mastectomy, which removes the entire breast. Palmer believes the advantage of subcut over lumpectomy is that it eliminates the possibility of any cancer cells being left behind.

Of the 140 women on whom Palmer has operated, six had it as a just in case measure.

"We use silicone for everything these days," he says. "There is no evidence that implants cause significant problems."

But a recent study published in the letters section of the Lancet (30 May 1992) from several researchers at the Fred Hutchinson Cancer Research Center in Seattle, Washington, found a 2.2 risk of breast cancer from silicone in women under 45 and a 30 per cent increase in those between 50 and 64. Although there has been much clinical evidence about autoimmune dangers and discomfort, there has never been a safety test.

Currently the US Food and Drug Administration has called for the first such rigorous safety trial.


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