Many factors can lead someone to choose a prophylactic mastectomy. Below, we’ll discuss the most common reasons to have this surgery, how well it works, and its risks.
What Is a Prophylactic Mastectomy?
- Simple/Total Mastectomy Removal of the entire breast, skin, nipple, and areola
- Modified Radical Mastectomy Removal of underarm lymph nodes in addition to the same tissues as a simple mastectomy
- Radical Mastectomy Removal of chest muscle in addition to everything removed in a modified radical mastectomy. This procedure is rarely done now, especially as preventive surgery.
- Skin-Sparing Mastectomy Removal of breast tissue, nipple, and areola, leaving the skin in place for immediate or future breast reconstruction
- Nipple-Sparing Mastectomy Removal of breast tissue, leaving the skin, nipple, and areola in place for reconstruction
Reasons to Get a Prophylactic Mastectomy
“There are many reasons for someone to get [a] prophylactic mastectomy,” says Mehra Golshan, MD, the deputy chief medical officer for surgical services at Yale Cancer Center and Smilow Cancer Hospital and a professor of breast oncology surgery at Yale School of Medicine in New Haven, Connecticut.
BRCA Mutations
“The most common indication [for a prophylactic mastectomy] is a hereditary mutation, such as those in the BRCA1 or BRCA2 genes,” says Monique Gary, DO, a breast cancer surgeon and the medical director of the Grand View Health Penn Cancer Network cancer program in Sellersville, Pennsylvania.
Family History
Current Cancer
Radiation Therapy
“The combination of these [risk factors], measured through a risk calculator, can yield an unacceptable level of risk to the patient, and prophylactic mastectomy may be one of the risk-reducing strategies offered,” says Gary.
Does Prophylactic Mastectomy Prevent Breast Cancer?
But prophylactic mastectomy dramatically reduces your breast cancer risk, says Golshan. “It’s an important option to discuss with [those who have] high-risk genetic mutations and those who have developed breast cancer.”
Prophylactic Mastectomy Risks
All surgery comes with risks, and a prophylactic mastectomy is no exception. “Risks of prophylactic mastectomy can include post-mastectomy pain, loss of sensation to the skin and nipples, or the need for further surgery based on blood supply and reconstructive options and outcomes,” says Gary.
Chest numbness is very common after a mastectomy, says Peled, and some people feel chronic pain. A pioneer in sensation-preserving mastectomies, Peled uses specialized surgical techniques to avoid nerve injury during surgery. Experts continue to research better methods for nerve preservation for those choosing reconstruction, adds Golshan.
The risks with this procedure extend beyond the physical effects. “There are also potential psychological side effects following mastectomy, including negative impact on body image, sexuality and intimacy, and sense of self,” Peled says.
Gary agrees, and says that good pre-surgical counseling is essential to establish expectations and set people up for post-surgical success. “It’s vital that all information be shared so the woman has a full understanding of indications, risk, benefits, and non-surgical alternatives to reducing risk over her lifetime,” Gary says.
Reasons Not to Get a Prophylactic Mastectomy
“Mastectomy is generally not indicated for women with no family history, women with [genetic] variants of uncertain significance, or changes in their hereditary gene panels that are not…likely to cause breast cancer,” says Gary. “Fear should not be the guiding factor; it must be a well-informed decision.”
Golshan agrees, adding that some patients ask for a prophylactic mastectomy to avoid imaging or for benign growths, but he advises against this. “There needs to be a thorough discussion of pros and cons when discussing prophylactic mastectomy along with the reconstruction options,” Golshan says.
Cost Considerations
Where to Find Support Before, During, and After a Prophylactic Mastectomy
Life with high breast cancer risk can feel isolating. Support from family and friends can help you cope with your decisions and experience. In addition, many people at risk for breast cancer find comfort in speaking with others facing similar decisions.
There are resources and support organizations available to help you through this journey. You can look through our comprehensive list of breast cancer resources that offer information, insight, and community support.
The Takeaway
A prophylactic mastectomy (the surgical removal of your breasts) can decrease your risk of breast cancer by up to 95 percent. Those who may most benefit from this procedure include anyone with BRCA1 and BRCA2 gene mutations, family or personal history of breast cancer, and previous radiation therapy. If you have any of these risk factors, ask your healthcare provider if a prophylactic mastectomy may be right for you.
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