In the early days of surgery, surgeons tried to out do each
other in their ability to perform bigger operations, and mastectomy was no
exception. For breast cancer, excising the tumour seemed like logical
treatment, at least for local control. It also seemed logical that if some excision was good, more excision was better. So simple
tumour excision soon gave way to simple mastectomy, which gave way to total
mastectomy, which gave way to radical mastectomy, which gave way to things like
the ‘extended’ radical mastectomy and the ‘supra-radical’ mastectomy (which
included excising the chest wall, amongst other things). Yet, all of this
effort was done without properly evaluating the effectiveness – it was all
based on what seemed like a good idea.
