Key Benefits and Risks Explained

In prophylactic mastectomy surgery, one or both breasts are removed to reduce a person’s risk of breast cancer.

This preventive treatment can lower breast cancer risk by at least 90 percent, according to the American Cancer Society (ACS), and research shows more and more women are turning to this method of breast cancer prevention.

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?

A mastectomy is the surgical removal of all or part of a breast,

 and the term “prophylactic” means prevention or protection.

 To prevent breast cancer, your doctor may recommend the removal of one or both breasts to reduce your cancer risk.

There are several types of mastectomies:

  • 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
The type of prophylactic mastectomy your provider recommends will depend on your breast cancer risk level, genetic markers like the BRCA1 and BRCA2 gene mutations, and other factors that are explained below.

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.

BRCA genes help repair damaged DNA that can lead to uncontrolled tumor growth, but sometimes these genes mutate (change). When this happens, the breast cells cannot fix DNA damage, which leaves you more prone to cancer growth in the breast.

But for women with these BRCA gene mutations, prophylactic mastectomy can result in dramatic risk reduction in breast cancer, says Dr. Golshan.

Family History 

“Sometimes patients have elevated [breast cancer] risk based on strong family history,” says Dr. Gary. This risk goes up if an immediate family member like your mother, daughter, or sister has or had breast cancer, and the risk increases even more if they received their diagnosis before the age of 50.

 This increased risk may prompt your doctor to recommend a prophylactic mastectomy.

Current Cancer 

Some people who have received a cancer diagnosis in one breast elect to have the other breast removed, too, in an operation called a contralateral prophylactic mastectomy. This procedure can lower the risk of a second cancer, in the unaffected breast.

Radiation Therapy 

Any history of radiation therapy to your chest, especially between ages 10 and 30, increases your risk of breast cancer.

 Depending on your radiation treatment history and other factors, this may prompt your doctor to recommend a prophylactic mastectomy.

“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.

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