What is a Prophylactic Mastectomy?
A prophylactic mastectomy is a preventative surgery to remove one or both breasts to reduce the risk of breast cancer. The surgery may also be called a risk-reducing or preventive mastectomy.
A prophylactic mastectomy can reduce your risk for breast cancer by up to 90% if you have a very high risk of developing the disease, according to the National Cancer Institute (NCI). Very high risk means you have at least a 20% chance of developing breast cancer in your lifetime, based on multiple factors.
When is Prophylactic Mastectomy the Right Choice?
If a woman has no family history of breast cancer and no genetic markers that increase her risk, she can expect her chance of getting the disease to be around 1.5 percent. Prophylactic mastectomy— removing both breasts before cancer develops—isn’t medically indicated for these low risk women.
But for women with a family history or specific genetic markers, the risk is much greater. In the case of actress Angelina Jolie’s much-publicized prophylactic mastectomy, she indicated that she had an 87% chance of getting the disease. In these situations, doctors may recommend a prophylactic mastectomy.
Some women with a BRCA1 or BRCA2 gene mutation have a lifetime risk of up to 87% for breast cancer and 53% for ovarian cancer.
Other factors that may increase your risk include:
- Having already had cancer in one breast
- Having a strong family history of breast or ovarian cancers
- Having dense breast tissue
- Exposure to radiation therapy at an early age
- Having other gene mutations
Patients should discuss their personal history with their doctor to decide what procedure is right for them. High-risk patients should be referred to a genetic counselor to assess their personal and family history to determine if they could benefit from genetic testing.
Mastectomy surgery today differs dramatically from those used even ten years ago. The results are excellent, with minimal scarring and an aesthetically pleasing cosmetic outcome after reconstruction—which is usually performed as a second stage of the mastectomy surgery.
How Effective is a Prophylactic Mastectomy?
The procedure is effective: It reduces cancer risk by 90% or more, depending on family history and genetic markers. (Women with a BRCA1 mutation and a first-degree relative with breast cancer have a 55-65% risk of developing breast cancer by age 70; after prophylactic surgery, this drops to 5%.) But since it’s impossible to remove every single cell in the breast tissue and guarantee that none will ever go rogue, a slight risk of developing breast cancer remains.
Are There Alternatives to Prophylactic Mastectomy?
Prophylactic mastectomy is only one of several options for people who have a high risk of developing breast cancer. The most common alternative is careful and frequent monitoring for any signs of the disease, with rapid treatment if any are found. Other choices include:
- Lifetime surveillance. This approach consists of mammograms, physical exams, and ultrasounds every 3-6 months for the rest of the patient’s life.
- Chemoprevention. Tamoxifen is a medicine that can decrease the risk of developing breast cancer in high-risk patients by almost 50%. However, there are many side effects associated with this medication, and it isn’t recommended for all high-risk patients.
- MRIs in addition to mammograms. MRIs are more sensitive and can detect smaller cancers, but they also have a much higher false-positive rate than mammograms alone.
- Surgery to remove the ovaries (prophylactic oophorectomy). This procedure has been shown to decrease the risk of breast and ovarian cancer. Prophylactic oophorectomy may reduce the risk of breast cancer in women at high risk by up to 50% if performed before the age of 50 when women are premenopausal.
- Healthy Lifestyle. Maintaining a healthy weight, exercising regularly, limiting alcohol consumption, and abstaining from hormone therapy during menopause may help reduce your risk of developing breast cancer.
Options in Prophylactic Mastectomy
Options in prophylactic mastectomy include a simple mastectomy, a modified radical mastectomy, and a skin-sparing or nipple-sparing mastectomy.
- A simple mastectomy involves the removal of most of the breast tissue but not the lymph nodes. It’s also called a total or radical mastectomy.
- In a modified radical mastectomy, which is the most common type of prophylactic surgery, doctors remove as much tissue as possible while preserving the chest wall muscles.
- In a skin-sparing or nipple-sparing mastectomy, surgeons remove all breast tissue while leaving healthy skin and nipples intact.
Innovative breast-conserving surgical procedures, such as the SWIM, Goldilocks, or direct-to-implant techniques developed by the pioneering surgeons at Bedford Breast Center, enable reconstruction to be performed as a second stage during a single surgery. These procedures can eliminate the need for traditional reconstruction techniques involving tissue expanders and multiple surgeries.
About the Procedure
During the procedure, doctors remove one or both breasts. If you opt for prophylactic mastectomy, you may wish to undergo breast reconstruction concurrently. The expert surgeons at Bedford Breast Center in Beverly Hills, CA, will discuss all the options and help you make the best choice for you.
Prophylactic mastectomy is performed with the patient under general anesthesia.
Details of the procedure will vary if reconstruction is performed concurrently and depending on which reconstruction technique is performed.
The surgeons at Bedford Breast center perform mastectomy through a small incision, made along the inframammary fold (the fold beneath the breast), the breast tissue is freed from the chest wall and removed. The muscles of the chest wall aren’t cut. The blood vessels and lymphatic vessels that supply the overlying breast tissue are identified and ligated.
The nipple isn’t removed in prophylactic mastectomy but may be moved to a new location on the breast mound.
A small drain is usually placed in each breast to remove fluid for several days following surgery. The incisions are closed with sutures, which will be removed at your first postoperative visit or may dissolve on their own.
What to Expect from Your Recovery
You’ll experience some pain during the first few days after surgery. Pain medication is typically prescribed, which should be sufficient to control any discomfort.
Most patients find that the most intense pain occurs in the first 24-48 hours postoperatively and begins to improve on the second or third day after surgery. You may experience a dull ache in your chest wall for up to six weeks following surgery.
The surgical drains (small tubes that collect fluid from your chest) are placed during your operation. These are usually removed two to four days following surgery, depending on the amount of fluid they collect. You’ll be given specific instructions regarding drainage care while in the hospital and when you are discharged home.
You may shower 48 hours after your drain removal or at your doctor’s discretion. You may wash your hair when you shower, but don’t submerge your incisions in water until all your sutures have been removed.
Contact our Medical Center to Find Out if Prophylactic Mastectomy is Right for You
At Bedford Breast Center, we understand that you have questions and concerns as you consider a prophylactic mastectomy. We recommend consulting with a breast specialist to explore all your available options and make the best surgical decision for you. Contact one of our breast specialists for more information or to schedule an appointment at our leading-edge Beverly Hills, California, medical center.