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 high-risk women may be able to reduce the risk of developing breast cancer by 90%.

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Is prophylactic mastectomy right for you?

If you are at high risk for 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: Your mother, sister, or daughter had breast cancer, especially before age 50.
  • You’ve tested positive for BRCA1, BRCA2, or PALB2 gene mutations, 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), or you have dense breasts. If your doctor finds a cluster of microcalcifications in your breast, it can sometimes mean that breast cancer is present. If you have dense breasts, it can be difficult for doctors to diagnose breast abnormalities and sometimes requires the removal of tissue samples to study under a microscope (biopsy). If a person has to undergo multiple biopsies because of many microcalcifications or dense breasts, the scar tissue that is created can complicate mammography and physical examination. While rare, some women with these conditions 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.
  • Subcutaneous mastectomy: During subcutaneous (“nipple-sparing”) mastectomy, all of the breast tissue is removed, but the nipple is left alone. Subcutaneous mastectomy is performed less often than simple or total mastectomy because more breast tissue is left behind afterwards that could later develop cancer. Some physicians have also reported that breast reconstruction after subcutaneous mastectomy can result in distortion and possibly numbness of the nipple. Because subcutaneous mastectomy is still an area of controversy among some physicians, your doctor may recommend simple or total mastectomy instead.

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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, so 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 for 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 Mastectomy section.

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

Combined prophylactic surgery to reduce risk of both breast and ovarian cancer

A small 2008 study of 12 women showed that having prophylactic ovary removal and prophylactic mastectomy at the same time was safe and successful. Seven years after surgery, none of the women developed a new cancer. Although more study is needed, combining the two surgeries can both reduce risk and allow a woman to avoid a second surgery and hospitalization. Read more about this study.

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