Preventing Breast Cancer: Your Mastectomy Guide
People at very high risk of breast cancer might consider a preventive mastectomy, also known as a prophylactic mastectomy. The surgery greatly reduces breast cancer risk but is a highly personal decision.
As research undercovers the many risk factors of certain types of cancers, people with those risk factors have more options to reduce their chances of developing these diseases.
Some people have a higher risk of breast cancer because of certain gene mutations. Learning about this risk means deciding whether to have a prophylactic mastectomy, which is a surgery that removes both breasts to reduce the risk of breast cancer.
The procedure makes it far less likely a person will develop breast cancer, but there are other factors to consider. Ultimately, it’s a decision someone makes after consulting with doctors and personal reflection.
This article reviews who might consider a prophylactic mastectomy, how to manage the emotional and psychological effects of the decision, and what happens during the procedure.
When is a preventive mastectomy recommended?
People at very high risk of breast cancer might consider a prophylactic mastectomy, also called a preventive mastectomy.
High risk factors for breast cancer include:
A prophylactic mastectomy is generally not recommended for people with an average or slightly elevated risk of breast cancer.
Your personal risk of developing breast cancer depends on what risk factors you have. A review paper from 2018 cites prior research to outline how much some risk factors might increase the chances of having breast cancer:
Other research gives slightly different numbers. A 2023 paper lists the risk of developing breast cancer by 70 years old is 57% to 65% with the BRCA1 mutation and 45% to 47% with the BRAC2 mutation.
Benefits and risks of a mastectomy
Perhaps the greatest benefit of prophylactic mastectomy is reducing breast cancer risk: It can reduce the risk by 90% or more.
However, there’s no type of mastectomy surgery that can guarantee you won’t get breast cancer. It’s not possible to remove all breast tissue cells.
As with any surgery, there are some risks to mastectomy. Side effects and complications can include:
Some people may not be candidates for a prophylactic mastectomy. For instance, people who have other significant health conditions may have an increased surgical risk.
If you’re considering a prophylactic mastectomy, a doctor can review your personal risks with you.
What are the types of mastectomies?
People who elect to undergo prophylactic mastectomies typically choose bilateral mastectomies, which is a removal of both breasts.
There are two main types of prophylactic mastectomies:
- Simple mastectomy: Also called a total mastectomy, a simple mastectomy removes the breast, nipple, areola, fascia of the main chest muscle, and the skin.
- Nipple-sparing mastectomy: This procedure removes the breast tissue. The breast skin, nipple, and areola all stay in place.
If a surgeon finds breast cancer cells in the breast tissue under the nipple and areola, then the nipple and areola are also removed, even if the intent is to perform a nipple-sparing mastectomy. However, this is pretty rare. The chance of finding cancer during a prophylactic mastectomy is less than 2%.
Tips for making a decision
When you’re weighing your options for breast cancer prevention, it’s crucial to consult with medical experts. However, the decision is ultimately up to you and depends on your personal needs and wants.
Consult with medical experts
If you have a family history of breast cancer, a doctor might suggest you see a genetic counselor. This is a healthcare professional with special training in medical genetics.
A genetic counselor will take a detailed family and medical history and discuss whether you might have a gene mutation such as BRCA1 or BRAC2. They might then ask you if you want to receive genetic testing.
You may also choose to consult with a cancer doctor called an oncologist. They can explain your preventive options, including a mastectomy. They might also refer you to a surgeon who can describe the surgery in detail, including its risks and benefits.
Take your personal needs into account
Whether to have a prophylactic mastectomy is a highly personal choice. Your reasons might not be the same as others. But for many people, there are a few motivating factors.
People who are parents might want to reduce their risk of breast cancer so they can be there for their children in the future. Individuals of all ages get prophylactic mastectomies, but most are in their 30s and 40s.
Some people experience anxiety at the thought of a lifetime of preventive cancer screening. A mastectomy offers an alternative. This anxiety might particularly arise when a person gets close to the age where a loved one received a breast cancer diagnosis.
After a prophylactic mastectomy, you will not require any additional annual screening imaging, such as mammograms, ultrasounds, or MRIs, than what is standard.
Navigating the psychological impact of your decision
Often, people who are weighing the option of having a prophylactic mastectomy share this decision with spouses, partners, and family members.
Not all of these individuals will understand or agree with your choice, which can be difficult. Spouses might find it hard to talk openly about the issue.
Spousal counseling and other forms of individual mental health counseling might help you manage these discussions, as well as the emotional and practical issues that arise.
Support groups for people who share your genetic diagnosis, such as groups for people who have the BRCA1 or BRCA2 gene mutation, can help you weigh the pros and cons of a prophylactic mastectomy.
They can also help relieve anxiety and distress over these decisions. Support groups can also be a place to discuss issues of changes in sexuality and body image after prophylactic mastectomy.
What to expect with the mastectomy procedure
A doctor or nurse will prepare you for what’s going to happen during your mastectomy. Here’s an overview of some things you can expect.
Before the mastectomy
A doctor will explain the procedure to you and ask if you have any questions. You will have to read and sign a consent form.
You might have blood tests or other testing on the day of surgery or before. You will discuss your medical history with a doctor and discuss any medications and supplements you currently take.
During the mastectomy
In the preoperative area, a nurse will review your medical information and place an IV into your arm. The anesthesia team will introduce themselves and explain their steps. The surgery team will also answer any other questions you may have.
You will then be wheeled to the operating room. The anesthesia team will administer general anesthesia, so you will fall asleep and not feel any pain. The surgical team will monitor your heart rate, breathing, blood pressure, and blood oxygen.
A doctor or nurse will clean your skin with a sterile solution. The surgeon will cut into your breast and remove the tissue underneath. They will place drainage tubes at the surgery site and close the skin with adhesive strips or stitches. They then cover the area with a surgical dressing.
After the mastectomy
The amount of time you stay in the hospital after your surgery varies from person to person. It’s often 1 to 3 days.
It takes a few weeks to recover completely from a mastectomy. The drainage tubes typically come out after 2 weeks. A doctor can give you pain relief options during recovery.
What are your breast reconstruction options?
If you decide to get breast reconstruction surgery, you have some options. You can opt for reconstruction with implants or with your body’s own tissue. This is called autologous tissue.
If you receive implants, the procedure starts after your mastectomy. A doctor places a tissue expander under the skin or chest muscle. You will visit the doctor periodically to slowly fill the expander with fluid until the chest tissue is healed.
In a separate surgery, the expander is removed and replaced with an implant of saline or silicone. This usually takes about 2 to 6 months. Sometimes, however, you can avoid a tissue expander, and an implant can be placed immediately after a mastectomy.
If the surgeon uses autologous tissue, the breast is reconstructed from skin, fat, and blood vessels from the abdomen, back, thigh, or buttocks. These tissue pieces are called flaps.
They are either moved through the body to the breast connected to the blood vessels (pedicled flap) or cut free from the blood vessels and then reattached using microsurgery (free flap).
A doctor can recreate a nipple using skin from the reconstructed breast. The areola is typically made later with tattoo ink.
Takeaway
A prophylactic mastectomy, also called a preventive mastectomy, may be an option if you have a very high risk of breast cancer. Assessing your personal reasons and consulting with medical experts can help you make the decision.
After a mastectomy, you might also choose to have breast reconstruction surgery. Talking with others who have a very high risk of breast cancer can help you manage the emotional and practical issues as you heal.
