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Benefits of Prophylactic Mastectomy

The term prophylactic mastectomy refers to the removal of one or both breasts prior to developing breast cancer in that breast. Most prophylactic mastectomies are performed after a patient has been diagnosed with breast cancer in one breast, and they wish to reduce their risk of developing cancer in the other breast. However, bilateral prophylactic mastectomy can be performed if patients are found to have a genetic risk factor and they desire to reduce their likelihood of ever being diagnosed with breast cancer. Otherwise, this is an unnecessary surgery for most women.

Factors to Consider

Patients that carry the BRCA1 or BRCA2 genes are considered to have a very high lifetime risk for developing breast cancer. Not all patients meet the criteria for genetic testing, but it should be considered if a diagnosis is made when the patient is younger than 45 years old or if multiple family members have been diagnosed with breast cancer.

In a relatively large population study of women that were BRCA1 or BRCA2 positive, the risk of breast cancer development was compared between those that chose to have a bilateral prophylactic mastectomy and those who did not. In the mastectomy group, 2 out of 105 (1.9%) women developed breast cancer compared to 184 out of 378 (48.6%) women in the non-surgical group. Additionally, the risk of developing breast cancer in the mastectomy group was decreased even further when a concurrent or previous bilateral oophorectomy, or removal of the ovaries, was performed. 1

Particularly if there is a strong family history of the disease, patients may express fear and anxiety over the possibility of ever developing breast cancer. These patients are more likely to choose a bilateral prophylactic mastectomy with or without prophylactic oophorectomy. The fear is very real and for some, peace of mind is priceless. 2

One study showed an increased trend toward unilateral or bilateral prophylactic mastectomies between 2005 and 2007 as a result of genetic testing. Approximately 97% of the prophylactic mastectomies performed were justified by positive genetic markers. Factors that were also associated include a history of depression, anxiety and hyperthyroidism. 3

Types of Prophylactic Mastectomy

There are two types of prophylactic mastectomy which can be used for unilateral or bilateral procedures. The first is a Total Mastectomy which removes all breast tissue including the nipple-areola complex. The other is a skin-sparing mastectomy, where the smallest amount of skin is excised along with all of the breast tissue. This allows for immediate reconstruction, if that is an option and decreases the potential need for tissue expanders.

Reconstruction can also be delayed, depending on the patient’s treatment regimen. Studies that surveyed women at a median time of three years after prophylactic mastectomy showed that satisfaction was 60% higher in those who underwent immediate reconstruction versus those who had delayed reconstruction. Factors that adversely affected satisfaction were decreased intimacy, feeling loss of femininity and partner’s perception of the changes after breast reconstruction.4  New techniques in reconstructive breast surgery have expanded the horizon of options available for immediate reconstruction.

Risks of Prophylactic Mastectomy

It is important to keep in mind that a prophylactic mastectomy does not guarantee that you will never develop breast cancer. There is an approximate 10% chance that you could develop breast cancer in the incision or scar tissue, in the axilla (armpit) or near the collarbone, as it is nearly impossible to remove every single cell of breast tissue.

Regardless of technique, there are always potential complications with any surgical procedure. Bleeding, infection and poor wound healing are the most common complications. These risks are generally considered to be low and the benefits of surgery far outweigh the risk of developing breast cancer. When determining what the best treatment plan is for you, talk to your doctor and discuss alternative treatment options. Having an active role in your treatment will give you satisfaction in knowing that you made the best possible decision regarding your health.

References

1 Rebbeck, T. R., Friebel, T., Lynch, H. T., et al (2004). Bilateral Prophylactic Mastectomy Reduces Breast Cancer Risk in BRCA1 and BRCA2 Mutation Carriers: The PROSE Study Group. Journal of Clinical Oncology , 1055-1062.

2 Haroun, I., Graham, T., Poll, A., et al. (2011). Reasons for risk-reducing mastectomy versus MRI-screening in a cohort of women at high hereditary risk of breast cancer. The Breast , 254-259.

3 Hoover, D. J., Paragi, P. R., Santoro, E., et al. (2010). Prophylactic Mastectomy in High Risk Patients: A Practice-Based Review of the Indications. Do We Follow Guidelines? Breast Diseases , 19-27

4 resser, P. J., Seynaeve, C., Gool, A., et al. (2006). Satisfaction with Prophylactic Mastectomy and Breast Reconstruction in Genetically Predisposed Women. Plastic And Reconstructive Surgery , 1675-1682

This article was originally published on July 27,2012 and last revision and update of it was 9/2/2015.