Prophylactic mastectomy

A prophylactic mastectomy is surgery to remove one or both healthy breasts to reduce the risk of developing breast cancer. This surgery is also called a preventive mastectomy. Removal of the healthy breast is prophylactic, or preventive, because the breast does not contain cancer.

Prophylactic mastectomy can lessen the risk of developing breast cancer by up to 90 percent in women who are at very high risk of developing the disease, such as those with a BRCA mutation. There are other reasons women may be at high risk. Ask your doctor about your personal risk of breast cancer and the impact of preventive mastectomy.

Bilateral mastectomy, also called a double mastectomy, involves removing both breasts. If you have been diagnosed with cancer in one breast, you may choose bilateral mastectomy to remove the other, healthy breast. This is called a contralateral prophylactic mastectomy.

Some reasons women consider a prophylactic mastectomy are:

• a strong family history of breast cancer.
• a BRCA or other breast cancer-related gene mutation.
• a diagnosis of cancer in one breast.
• a diagnosis of lobular carcinoma in situ. LCIS is not an immediate threat to your health, but it is a marker that you have a higher than average risk of developing breast cancer in either breast in the future.
• had radiation therapy to your chest for another cancer, usually for a cancer you had as a child.

Your doctor may recommend prophylactic double mastectomy if you have a BRCA mutation, which increases the chances of developing breast cancer by age 70 to 45 to 85 percent. If you were treated with a single mastectomy in the past and just learned you have a BRCA mutation, it’s OK to talk with your doctor about removing the other breast.

Depending on your family history, you should consider genetic testing before making a decision about surgery. If your doctors do not speak with you about genetic testing, consider bringing it up.

Decisions about prophylactic mastectomy

Prophylactic mastectomy is a major operation that has benefits and risks. Here are some things to consider:

• Prophylactic mastectomy can greatly reduce the risk of breast cancer. Still, it doesn’t guarantee you will never get breast cancer. Mastectomy does not remove every single piece of breast tissue, so there is still a chance breast cancer can grow in the small amount of remaining tissue.
• If you are at high risk for breast cancer, you may have other options besides prophylactic mastectomy. These can include extra imaging with screening MRI and taking medicines to reduce your risk of breast cancer. Talk with your healthcare team about a risk-reduction plan that’s right for your situation.
• For people diagnosed with breast cancer in one breast: In general, breast cancer experts do not feel it’s necessary to have prophylactic mastectomy in the opposite (contralateral) breast. It is very uncommon for breast cancer to spread from one breast to the other. Talk with your doctor about:
  • Your personal risk of recurrence
  • The risk of a new breast cancer in the opposite breast
  • Things you can do to monitor your risk, such as increased imaging tests
• The decision to have a prophylactic mastectomy is very personal. This is a major operation that can have a big emotional and physical impact. It can affect the way you feel about yourself and your body.
• Many people who undergo prophylactic mastectomy have the option of breast reconstruction. For some women, this surgery can help restore a sense of wholeness. Reconstruction can often be done at the same time as prophylactic mastectomy. Visit Breast reconstruction to learn more.
• “Going flat” is also an option if you do not want reconstruction after prophylactic mastectomy. A technique called aesthetic flat closure can create a smooth chest.
• Whether or not you have breast reconstruction, mastectomy requires a good amount of rest and recovery. Be sure to talk with your healthcare team about the side effects and recovery time involved in surgery. You will want to weigh the benefits of surgery against the risk of complications.

Side effects

Side effects of prophylactic mastectomy include:

• Short-term pain in the chest area
• Blood or fluid buildup at the surgery site
• Temporary or long-term limited range of motion in the shoulder and arm

Prophylactic mastectomy can also cause permanent numbness in the chest area, whether or not you have breast reconstruction. This happens because nerves are cut when breast tissue is removed.

If you have breast reconstruction or aesthetic flat closure, you may be able to have a nerve repair procedure to restore feeling in the chest. One type of nerve repair is called Resensation. This technique uses donated, sterilized human nerve tissue to connect cut chest nerves to nerves in the reconstructed breast or the remaining skin. Visit Breast reconstruction to learn more about nerve repair.

Learn more about types of mastectomy and potential side effects on the Mastectomy page.

Questions about preventive mastectomy

In considering prophylactic mastectomy, you and your doctor are likely to discuss:

• The benefits of prophylactic mastectomy compared to the risk of breast cancer
• The emotional and practical concerns of mastectomy
• The risks of the operation

Here are some suggested questions to ask your doctor:

• What does prophylactic, or preventive, mastectomy involve?
• What are the pros and cons?
• How effective is preventive mastectomy in my situation?
• What are the costs?
• Can you tell me about the hospital stay and recovery?
• What are the possible complications, and how can those be managed?
• What are my other options to reduce risk of breast cancer?
• What can I do if I don’t want to have prophylactic mastectomy?
• Does my health insurance cover the cost of prophylactic mastectomy?
• Who else should I talk to when considering prophylactic mastectomy?
• How can I get more information about breast reconstruction or a prosthesis?