Prophylactic mastectomy

A prophylactic mastectomy is surgery to remove one or both healthy breasts to reduce the risk of developing breast cancer. This surgery is also called a preventive mastectomy. Removal of the healthy breast is prophylactic, or preventive, because the breast does not contain cancer.

Prophylactic mastectomy can lessen the risk of developing breast cancer by up to 90 percent in women who are at very high risk of developing the disease, such as those with a BRCA mutation. There are other reasons women may be at high risk. Ask your doctor about your personal risk of breast cancer and the impact of preventive mastectomy.

Bilateral mastectomy, also called a double mastectomy, involves removing both breasts. If you have been diagnosed with cancer in one breast, you may choose bilateral mastectomy to remove the other, healthy breast. This is called a contralateral prophylactic mastectomy.

Some reasons women consider a prophylactic mastectomy are:

• a strong family history of breast cancer.
• a BRCA or other breast cancer-related gene mutation.
• a diagnosis of cancer in one breast.
• a diagnosis of lobular carcinoma in situ. LCIS is not an immediate threat to your health, but it is a marker that you have a higher than average risk of developing breast cancer in either breast in the future.
• had radiation therapy to your chest for another cancer, usually for a cancer you had as a child.

Your doctor may recommend prophylactic double mastectomy if you have a BRCA mutation, which increases the chances of developing breast cancer by age 70 to 45 to 85 percent. If you were treated with a single mastectomy in the past and just learned you have a BRCA mutation, it’s OK to talk with your doctor about removing the other breast.

Depending on your family history, you should consider genetic testing before making a decision about surgery. If your doctors do not speak with you about genetic testing, consider bringing it up.

Decisions about prophylactic mastectomy

It’s important to understand that prophylactic mastectomy doesn’t guarantee you will never get breast cancer. Mastectomy does not remove every single piece of breast tissue, so there is still a chance breast cancer can grow in the small amount of remaining tissue. If you choose preventive mastectomy, you can still talk with your doctors about other ways to reduce your personal risk.

Contralateral prophylactic mastectomy is your decision. But in general, doctors do not feel it is necessary for your cancer treatment. It is very uncommon for breast cancer to spread from one breast to the other. There are risks involved with extra surgery. Talk to your surgeon about the risks and benefits for you. You may also want to talk with your surgeon or your medical oncologist about your risks for recurrence, or the cancer coming back. Your doctors can help you better understand those risks, and how different preventive methods may affect your personal risk.

The decision to have a prophylactic mastectomy is very personal. Surgery can affect both your body and your emotions. Removing your breasts may cause worry or sadness over lost femininity or other body image concerns. You may also welcome surgery because lowering your risk may ease fears and anxieties.

A mastectomy is a major operation. It may require a good amount of rest and recovery. Be sure to talk with your healthcare team about the side effects and recovery time involved in surgery. You will want to weigh the benefits of surgery against the risk of complications. If you are considered high risk for breast cancer, you may have other options. These include extra imaging with screening MRI and taking medicines to reduce your risk of breast cancer.

If you have prophylactic mastectomy, you may be able to have breast reconstruction. You may also be eligible for nipple-sparing mastectomy, where the nipple-areolar complex is not removed.

Questions about preventive mastectomy

In considering prophylactic mastectomy, you and your doctor are likely to discuss:

• The benefits of prophylactic mastectomy compared to the risk of breast cancer
• The emotional and practical concerns of mastectomy
• The risks of the operation

Here are some suggested questions to ask your doctor:

• What does prophylactic, or preventive, mastectomy involve?
• What are the pros and cons?
• How effective is preventive mastectomy in my situation?
• What are the costs?
• Can you tell me about the hospital stay and recovery?
• What are the possible complications, and how can those be managed?
• What are my other options to reduce risk of breast cancer?
• What can I do if I don’t want to have prophylactic mastectomy?
• Does my health insurance cover the cost of prophylactic mastectomy?
• Who else should I talk to when considering prophylactic mastectomy?
• How can I get more information about breast reconstruction or a prosthesis?