Prophylactic mastectomy

Overview

A prophylactic mastectomy, also known as a preventative or risk-reducing mastectomy, is a surgical procedure that involves the removal of one or both breasts. This surgery is recommended by doctors for individuals at high risk of developing breast cancer, as it aims to significantly lower the likelihood of the disease occurring.

Reasons for undergoing the procedure

In the case that you have any of the following risk factors for breast cancer, you might decide to have a prophylactic mastectomy:

• Personal history of breast cancer: If you have been diagnosed with breast cancer in one breast and opt for a mastectomy, you might decide to also remove the other breast. This decision does not affect your overall prognosis or the need for further treatments.
• Family history of breast cancer: Your risk of developing breast cancer is notably higher if a close family member, like your mother, sister, or daughter, has had the disease. The risk is further elevated if this family member was diagnosed before the age of 50.
• Positive genetic test results: Genetic tests can identify mutations, such as those in the BRCA1 or BRCA2 genes. A positive result may lead you to consider a preventive mastectomy.
• Radiation therapy: If you have undergone radiation therapy to your chest area, especially between the ages of 10 and 30, your risk of developing breast cancer is increased.

Prophylactic mastectomies are used by doctors to lower the risk of breast cancer.

Undergoing a prophylactic mastectomy can significantly lower the risk of breast cancer:

• By 95% for those who carry a BRCA1 or BRCA2 gene mutation.
• By 90% for those with a strong family history of breast cancer.

Types of prophylactic mastectomy

There are various varieties of preventative mastectomy:

• A bilateral mastectomy involves the removal of both breasts.
• A contralateral mastectomy involves the removal of the healthy breast in individuals who have cancer in the opposite breast.
• A skin-sparing mastectomy involves making a little incision to remove the areola and nipple before removing the breast tissue.
• A nipple-sparingmastectomy that spares the nipple and areola eliminates just breast tissue.
• When a person has a double mastectomy with reconstruction, both breasts are removed and then rebuilt using implants or tissue from another part of the body.

Risks

The risks associated with a preventative mastectomy include infection, bleeding, and reduced sensation in the breast area. Additionally, you may feel dissatisfied with your body’s appearance after surgery, and the psychological impact of losing one or both breasts can be challenging to cope with. If you experience anxiety or concerns about your body image, it is advisable to consult a psychologist or other mental health professional. These experts can help you develop healthy coping strategies for difficult emotions, such as journaling, meditation, or joining a support group.

Before the procedure

Your doctor will provide you with instructions on how to prepare for a preventive mastectomy. Generally, no special preparations are required. On the day of the procedure, you will change into a hospital gown. A healthcare professional will then insert an intravenous (IV) line into your arm or hand. The anesthesia, administered through the IV, will help you relax and sleep through the surgery. Once you’re ready, you’ll be taken to the operating room for the procedure.

During the procedure

In the course of a preventative mastectomy, a breast surgeon:

• Creates a cut in your breast
• Divides the tissue of your breast from the muscles and skin of your chest
• Removes the breast tissue and starts reconstruction if it is part of your surgical plan
• Inserts long tubes (drains) into your breast to drain extra fluid while it heals
• Stitches the incision closed and covers the area with a bandage.

Typically, a preventative mastectomy requires two to three hours. If you are also having breast reconstruction, the surgery will take longer.

After the procedure

You may need to stay in the hospital overnight after a preventative mastectomy. The length of your stay will depend on several factors, including your overall health and whether you had reconstruction surgery. A doctor will teach you exercises to help reduce shoulder or arm stiffness post-surgery. These exercises are designed to minimize the formation of scar tissue. Before you leave the hospital, your surgical team will provide you with instructions on how to care for yourself at home.

Outcome

Recovery times after a mastectomy can vary. The initial healing process usually takes three to four weeks. If you also had breast reconstruction, recovery may extend up to eight weeks. It may take several months before you’re able to resume your regular activities.