Key Benefits and Risks Explained

MSNBCTV-STAFF

July 10, 2024

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.

Does Prophylactic Mastectomy Prevent Breast Cancer?

“No surgery can reduce the risk of breast cancer down to zero,” says Gary, adding that even after a double mastectomy, some risk still remains.

“All mastectomies leave some small degree of breast tissue behind,” says Anne Peled, MD, a breast cancer surgeon based in San Francisco. Sometimes breast cancer cells already exist in the lymph nodes or elsewhere in the body at the time of mastectomy, says Dr. Peled, and they may grow over time even after a prophylactic mastectomy.

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.”

According to Cleveland Clinic, a prophylactic mastectomy can lower your risk of breast cancer by 95 percent if you have BRCA1 or BRCA2 gene mutations and 90 percent if you have a strong family history of 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

Out-of-pocket costs for prophylactic mastectomy vary significantly among insurance carriers, but a study found that almost 40 percent of insurance policies cover prophylactic mastectomies for high-risk patients.

Among those insurance policies, all of them covered prophylactic mastectomy for people with BRCA gene mutations, but fewer insurers covered the procedure for risk factors such as previous radiation therapy or personal and family history.

To find out if your insurance carrier covers prophylactic mastectomy, you can call their customer service line to ask about your benefits.

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.

Source link