Boobs are unnecessary! How easily can you sacrifice yours?

For years, I have been telling my patients that they should not delegate their health decisions to doctors, and I advise them to be inquisitive and participatory in medical decisions. In fact, the reason for this is our breast surgeon friend Dr. I couldn’t explain it as clearly as Ceyhun İrgil! Most surgeons share his view but do not voice it. Otherwise, it is said that they needlessly operate thousands of women every day for masses unrelated to cancer, perform a mastectomy on the patient for whom they can perform preventive surgery for cancer, scrape their armpits unnecessarily even though the cancer is limited to the breast and render women’s arms dysfunctional for life (the only thing that matters is “function”! ) how would you explain? My words are not aimed at all surgeons, but the majority who do them heavily.

All women who have had surgery should turn to their pathology reports. If they do not see the diagnosis of “cancer” as a result of the pathology report, let them understand that they have been operated for nothing! If the cancer in their breasts is smaller than 2 cm, let them suspect that the mastectomy may have been done unnecessarily! If no metastases are found in the armpit, make sure that extensive axillary surgery (axillary dissection) is unnecessary!

The humiliation of women’s organs is related to the belittlement of women’s identity, and in fact, the two situations feed each other. Surgeons’ derogatory comments about the breast are as old as the earliest written documents dating back to BC. Beneath the humiliation lies the demigodly high egos of surgeons, who are mostly men! The submissive attitudes of women also play a role in feeding these egos!

For a better understanding, it is useful to refer to the historical background of the subject;

From the time of Hippocrates (460 BC) until the middle of the 20th century, the female body was considered underdeveloped, soft, flawed and inadequate compared to the male body. Menstrual bleeding and breasts were seen as biological signs of a woman’s inadequacy, hence her “inferior position.”

According to Galen (129-199), nature had made some adaptations to compensate for these deficiencies. Having the breast above the heart was one of these adaptations. Thus, the breast provided additional warmth and protection to the heart.

Pathologist Robert Virchow summarized the opinion of the late 1800s: “The woman consists of a pair of ovaries to which the human trait is attached. A man is a person to whom a pair of testicles is attached”.

The widespread judgment of the “worthlessness” of breasts among physicians has led to treatment methods for ages being no different than torture, lacking sufficient respect for the patient’s personality and organ. Breast cancer was a disgraceful disease in society, as treatment approaches emphasized the woman’s “inferiority”, a secret that could only be shared with the closest people, but still using carefully chosen words. In order not to be excluded from society, women would hide that they had cancer, and would take an apologetic approach to the doctor, putting themselves behind the scenes.

Although anesthesia was first used in 1846, it was not used in breast surgery until the 1900s because it was thought to be beneficial for women to relieve pain. Surgeons would try to persuade their patients to have a mastectomy without anesthesia, even if anesthesia was available. Older women were thought to feel less pain than younger women, and poor and lower-class women than wealthy and high-class women. So they would save the anesthetic for wealthy Caucasian women whom they believed should protect them from pain! The use of anesthesia for women of all ages, social classes and economic levels became possible in the USA after the 1920s. A significant part of breast surgery for biopsy purposes (in us) is still performed only with local anesthesia even today.

The most common treatment for breast cancer today is mastectomy, although it does not take much time.

Mastectomy means removal of the entire breast and usually also the axillary lymph nodes. It reduces the quality of life of women by causing severe physical deformity (deformity), pain, lymphedema (swelling in the arm) and psychological problems, but it does not prolong life in most patients!

However, even today, many surgeons consider these “side effects” as insignificant compared to the effort to keep the patient alive longer. The advice that Halsted, the father of the classical breast surgery, mastectomy, and the charismatic leader of surgery, gave to his students in an article in 1891, still holds true: “Injury is nothing compared to saving the patient’s life. Moreover, most of these women are elderly. Their average age is almost 55. So it can’t be said that they have a meaningful life anyway”!

In the USA in the early 1900s, every patient underwent a mastectomy, regardless of the extent of the cancer. But among the operated patients, those who lived longer than three years were actually only those with very small and limited breast (early stage) cancer. This indicated that life expectancy after surgery was more dependent on the stage at which the cancer was diagnosed, rather than the surgeon’s heroic battle with the cancer.

Recognizing the importance of early treatment in this way, surgeons founded the American Society for the Control of Cancer (ASCC) in 1913. The association gave the following message: “Smart women who want to win the battle against cancer! Check your breasts and if you feel a lump, go to a surgeon without delay. Your salvation lies in believing in the power of the surgeon. The only cure for cancer is emergency surgery”. Is it familiar?

By the 1920s, the ASCC’s campaign was well-known, and women began to pile up in front of surgeons’ offices. Interest in surgery had exploded among medical students in Europe and America, and those who wanted to learn the mastectomy technique competed to become students of famous surgeons.

Between 1905 and 1925, the number of breast surgeries increased rapidly, quadrupling the total number of all other surgeries. Halsted’s mastectomy had already broken the record for the most common major surgery in the world. In 1925 alone, 14,000 women died of breast cancer in the United States, but more than 20,000 had radical mastectomies. In a significant part of the women who had these surgeries, only benign (harmless) masses were found, not cancer.

In the 1940s, the Second World War also affected breast surgery. Major war wounds had led to surgeries of unprecedented scale and their becoming commonplace. Surgeons working on the battlefield performed hundreds of amputations each day, among other major surgeries. In this period, when the belief in surgery increased and amputations were taken for granted, mastectomies for breast cancers expanded even more.

At one time the most respected technique was the complete removal of the lymph nodes on either side of the breastbone, in addition to other areas. For this, some ribs were removed from both sides, and the intact breast was shifted towards the midline to fill the large pit opened in the middle. The patient would leave the hospital with a strange target-like breast that he had to carry in the middle of his chest for the rest of his life. Her patience with this tragic situation shows how much she trusted the surgeon she had elevated to the status of a demigod. As such, it was unacceptable for him to question, demand or complain about the surgeon who was fighting selflessly to save his life! Do you think it’s different now?

In the early 1950s, American surgeon George Crile Jr. shocked the medical world one after another by proving that first thyroid cancer surgeries were done to cause unnecessary disability, and then that some thyroid surgeries were unnecessary at all.

However, the real storm broke out when he expressed his opinion on breast surgeries and suggested the “conservative surgery” method, which was burgeoning in England and developed by him: “Many of these surgeries are done unnecessarily. Women are injured by unnecessary mastectomies. The life expectancy provided by conservative surgery is not different from that achieved by mastectomy. Moreover, the physical and psychological side effects of conservative surgery are much less. Why go with a mastectomy when the truth is so clear?”

Having grown up with the doctrine of radical surgery, Crile’s proposal, which could blow up this doctrine together with those inside, was met with suspicion and reaction among American surgeons. The possibility that the invention that had sprouted in Europe now spread to America through Crile had created fear and anxiety. They accused him of opposing “the scientific doctrine accepted by the whole world” and of being a charlatan.

As her suspicions grew, Crile questioned the American Society of Surgeons’ (ACS) public message to “go to the surgeon for early detection”: “Women lose their breasts even if the mass is benign. When the cancer is in an advanced stage, their breasts cannot be removed and they cannot be kept alive for a longer period of time. So who does it benefit ‘other than a surgeon’ for women to go to the surgeon?”

Between 1950 and 1955, Crile took every opportunity to explain her findings and share her ideas at medical conferences and medical journals, but failed to make any progress: “My efforts are futile because patients are unaware of the debates about their fate. It is claimed that they will not want conservative surgery in environments where they are not present. However, they should have the right to decide on matters related to them”.

Thus, Crile resorted to the last resort, hoping to change the surgical approach, which he did not find scientific and ethical, and tried to reach surgeons through public demand.

In an article in Life magazine in 1955, he made his thoughts public: “If doctors do not agree on which treatment is ‘best’, my answer to the question of who should decide what to do is ‘it has to be given by the patient’. A sane adult is the only person who can make the right decision for himself! He should not leave the choice to the doctor by saying, ‘The doctor knows best’!”

In his book “Cancer and Common Sense”, which he published at the same time, there were these lines: “The idea of ​​’emergency surgery’ in the treatment of breast cancer is wrong because there is no difference between the results of emergency surgeries and those performed after a while. The surgeon should give the patient time to evaluate the treatment options well”.

Crile’s public release was found to be against the rules of “medical ethics” and led to her excommunication from the medical community. The American Medical Association interpreted this behavior as an effort to gain unfair advantage and publicity by humiliating its colleagues in the eyes of the public, and said: “We do not dispute the accuracy of what you say, but you should not have made it public. These are the things doctors will only talk about among themselves”!

The American Society of Surgeons, the National Cancer Council, and the American Medical Association filed a joint statement in the journal Life, in which Crile’s article was published, publicly complaining about Crile: “Due to our responsibility, Dr. We consider it our duty to inform the public that we find Crile’s philosophy on cancer quite fatalistic and dangerous”.

When the crile storm was calmed in this way and the “danger” it created for his colleagues was eliminated, preventive surgery was left out of the agenda in America. Thus, the familiar radical surgeries continued in all their glory until Crile (forced by popular pressure) was recalled in the 1980s.

In our country, the people are still far from questioning, they consider whatever they are given to be acceptable. Therefore, radical surgeries are easily accepted. Big doctors say that the reason for the existence of the breast is to give pleasure to women and men and to feed babies! When the woman’s fertility and sexual role are over, her need for breasts ends! Just like the uterus and ovaries, the breasts are also non-vital things that do not need to be protected and can be easily sacrificed!”.

The latest and greatest description is Dr. From Ceyhun İrgil: “When we look at the breast in its essence, it is a fat mass that fills the palm of our hand, almost tail fat. It is the essence and everything. It is unnecessary after its function is over”

All people have organs whose functions decrease or disappear completely after a certain age. But they are not only a part of our physical identity, but also a part of our spiritual identity throughout our lives. Wouldn’t it normalize this idea to state that an organ can easily be sacrificed medically just because its function is reduced or lost? How protective can the “conservative surgery” performed by a surgeon who thinks like this actually be? Dr. Does the silence of our physicians, especially surgeons, in the face of İrgil’s comments mean that they agree with him? If not, shouldn’t they show their reactions and inform the public? Or are these things that doctors can only talk about among themselves, as is habitually said?

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