Prophylactic Mastectomy

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What is prophylactic mastectomy?

Prophylactic mastectomy is surgery to remove one or both breasts to reduce the risk of developing breast cancer. According to the National Cancer Institute, prophylactic mastectomy in women who carry a BRCA1 or BRCA2 gene mutation may be able to reduce the risk of developing breast cancer by 95%. In women with a strong family history of breast cancer, prophylactic mastectomy can reduce the risk of breast cancer development by up to 90%.

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Is prophylactic mastectomy right for you?

If you are at high risk of developing breast cancer, you might be exploring possible ways that you can reduce this risk. While prophylactic mastectomy can significantly reduce risk of developing breast cancer, this surgery is also a serious choice that can have a considerable impact on your life.

There are many factors to consider when deciding on a risk-reduction strategy, so take the time you need to talk to your doctor and family members about the different ways you can lower your risk.

You may be considering risk-reducing measures such as prophylactic mastectomy if:

  • You have a strong family history of breast cancer: More than one relative — including your mother, sister, or daughter — has had breast cancer, especially before age 50.
  • You’ve tested positive for a BRCA1, BRCA2, PALB2, CDH1, PTEN, or TP53 gene mutation, which increase the risk of breast cancer.
  • You have a personal history of breast cancer, making you more likely to develop a new cancer in the opposite breast than someone who has never had breast cancer.
  • You have been diagnosed with lobular carcinoma in situ (LCIS), which has been shown to increase the risk of developing invasive breast cancer.
  • You have had radiation therapy to the chest before age 30, which increases the risk of breast cancer throughout your life.
  • You have widely spread breast microcalcifications (tiny deposits of calcium in the breast tissue). If your doctor finds a cluster of microcalcifications in your breast, it can sometimes mean that breast cancer is present. If a person has to undergo multiple biopsies because of many microcalcifications, the scar tissue that is created can complicate mammography and physical examination. While rare, some women with repeated incidences of microcalcification clusters decide to undergo prophylactic mastectomy.

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Prophylactic mastectomy plus reconstruction

Women who decide to have prophylactic mastectomy often choose to have breast reconstruction surgery, either at the same time as prophylactic mastectomy or at a later time. Learn more about breast reconstruction.

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Prophylactic mastectomy: What to expect

People receiving prophylactic mastectomy will have one of the following procedures:

  • Simple or total mastectomy: During simple or total mastectomy, the nipple, areola, and all of the breast tissue are removed. Axillary lymph node dissection (removal of the underarm lymph nodes) is not performed, and no muscles are removed.
  • Skin-sparing mastectomy: During skin-sparing mastectomy, the surgeon removes only the skin of the nipple, areola, and the original biopsy scar. Then the surgeon removes the breast tissue through the small opening that is created. The remaining pouch of skin provides the best shape and form to accommodate an implant or a reconstruction using your own tissue. Skin-sparing mastectomy can be performed as a simple or total mastectomy to provide the skin needed for immediate reconstruction.
  • Nipple-sparing mastectomy: During nipple-sparing mastectomy, all of the breast tissue is removed, but the nipple is left alone.

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Prophylactic mastectomy risks

Prophylactic mastectomy surgery, like mastectomy to treat breast cancer, has some risks:

Risks immediately after surgery:

  • bleeding or infection
  • fluid collecting under the scar
  • delayed wound healing
  • scar tissue formation

Long-term risks:

  • Prophylactic mastectomy is permanent and irreversible.
  • This surgery causes significant loss of sensation in the breast, which can have an impact on sexuality.
  • Women who undergo prophylactic mastectomy will no longer have the ability to breastfeed from the affected breast(s).
  • After prophylactic mastectomy, some women experience anxiety or depression about body image.
  • Although prophylactic mastectomy may reduce the risk of developing breast cancer by about 90%, it doesn’t guarantee that breast cancer will never happen. Breast tissue can sometimes extend to the collarbone and armpit, and it’s not possible for a surgeon to remove every last cell. Breast cancer can develop even in the small amount of tissue that remains.

If you’re at high risk of developing breast cancer, it’s important to discuss all your options for risk reduction with your doctor and loved ones. It’s also important to seek a second opinion about whether or not prophylactic mastectomy is a strategy that works for the whole you — your medical situation and your quality of life.

To learn more about what to expect before, during, and after mastectomy surgery, visit the Breastcancer.org Mastectomy section.

To connect with others who are facing breast surgery, join the Breastcancer.org Discussion Board forum Surgery - Before, During, and After, which includes threads connecting members based on their surgery month.

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