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A Piece of My Mind |

Who’s Afraid of the Empowered Patient?

Delia Chiaramonte, MD
JAMA. 2008;300(12):1393-1394. doi:10.1001/jama.300.12.1393.
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“Here, feel this,” my friend said, lifting her shirt. Under my fingers, in her 41-year-old breast, was a rock-hard mass.

After a hellish 6 months of crippling nausea, fatigue, and the amputation of one of her breasts, Shelly (not her real name) felt battered, poisoned even, by her wild ride through the medical machine. She wanted a new breast, a good one, and she hoped her research would help her get one. She learned about the TRAM flap, implants, and a newer procedure called the DIEP. The TRAM flap, which uses abdominal skin and fat to create a breast, would require the sacrifice of all or part of her rectus abdominis muscle. The DIEP, on the other hand, would preserve her abdominal muscles and allow for a quicker recovery. She had consulted her support group, her sister the nurse, her friend the physician, and, of course, the Internet. She knew what she wanted—the DIEP procedure—and she had dutifully followed the steps to get it—a referral to an in-network plastic surgeon, weeks of waiting, then baring her misshapen chest to the studying eyes of a stranger.

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