What is prophylactic mastectomy?

A prophylactic mastectomy is a preventive option for those who are at high risk for breast cancer. A typical mastectomy occurs after a breast cancer diagnosis, but with a prophylactic mastectomy, the procedure is done without a cancer diagnosis.

There are several types of mastectomy procedures to discuss with your doctor. They involve the removal of one or both breasts by a board-certified plastic surgeon.

Why might I choose a prophylactic mastectomy?

You might consider a preventive mastectomy for several reasons, including:

• Genetic mutations. People with mutations in the BRCA1 or BRCA2 genes have a much higher risk of developing breast cancer. A prophylactic mastectomy can reduce this risk by up to 95%. A doctor or genetic counselor can recommend genetic testing based on your family history and other risk factors, which will help inform whether preventive surgery is the right option for you.
• Family history. A strong family history of breast cancer, especially if close relatives were diagnosed at a young age (before the age of 50). A prophylactic mastectomy can reduce this risk by up to 90%.
• Personal history of breast cancer. Those who have already had breast cancer in one breast might choose to remove the other breast to prevent a second occurrence.
• Radiation therapy. A history of radiation therapy to the chest, particularly during childhood or young adulthood (before the age of 30), increases the risk of breast cancer.
• Lobular carcinoma in situ (LCIS). This condition, in which abnormal cells are found in the milk glands, shows a higher risk for developing breast cancer.

If you have these or other concerns about breast cancer, talk with your doctor about the best option for your individual needs.

Risks of Prophylactic Mastectomy

Like any surgery, a prophylactic mastectomy comes with risks and side effects that might affect your quality of life as you recover. Because of this, preventive surgery is usually not recommended for those who have an average or only slightly higher than average risk of developing breast cancer.

A prophylactic mastectomy greatly reduces your risk, but it doesn’t guarantee that you will not develop breast cancer.

Emotional Impact of Prophylactic Mastectomy

Seeking support from loved ones, joining support groups and speaking with mental health professionals can be important when coping with the emotional impacts of a mastectomy. Overall, while the decision can bring significant emotional challenges, it can also offer a sense of empowerment and control.

• Relief and reduced anxiety. This proactive step can provide peace of mind and a sense of control over your health.
• Body image and self-esteem. Some people may struggle with changes in their appearance and feel less feminine or attractive. Loss of sensation in the breast can cause sexual dysfunction and stress.
• Recovery time stress. A prophylactic mastectomy is a major surgery that requires recovery time. You will have bandages, stiches and a surgical drain as you heal, and will need prescribed pain medication. Patience throughout your healing process will help alleviate the stress of recovery time.

Breast Reconstruction After Prophylactic Mastectomy

There are several options for breast reconstruction, whether it is done directly after your mastectomy or later as a separate surgery. If you are not interested in more surgery, you may choose not to have breast reconstruction at all.

Your doctor will review which type of breast reconstruction would be a fit for you.