To the Editor.—The article on subcutaneous mastectomy by Shons and Press1 is one that I must comment on.
The subject of prophylactic mastectomy is receiving a lot of attention. However, the term subcutaneous mastectomy should not be used interchangeably with the term prophylactic mastectomy. The problem comes up as to who should have a prophylactic mastectomy.
Personally, I divide my patients into two groups. The first has already had a mastectomy and is at high risk of involvement of the second breast. Every patient coming in to discuss reconstruction is told of the possibility of a prophylactic mastectomy on the remaining breast before carrying out bilateral reconstruction.
The article helps to draw together factors that aid us in identifying the woman at high risk. There is no question that this is a difficult problem; only from experience can one gain a "gut reaction" to help in advising these