In hopes of avoiding cancer, some high-risk women elect to have both breasts surgically removed, a procedure called bilateral prophylactic mastectomy. The surgery removes all breast tissue that potentially could develop breast cancer. Preventive breast cancer surgery also may be considered if a woman has already had breast cancer, because she is at increased risk for developing breast cancer again in the other breast. Prophylactic mastectomy refers to the removal of healthy breast tissue to reduce a woman’s risk of developing breast cancer. It is the most effective means of reducing risk, but the benefits of such a surgery depend on the level of an individual’s risk.
How much is the risk reduced?
A recent study suggests that prophylactic mastectomy may reduce the risk of breast cancer by at least 90 percent.
Physiological challenges of prophylactic mastectomy
Breast tissue is composed primarily of fat tissue, connective tissue, and glandular tissue, which produces milk. It is in the glandular tissue of the breast that breast cancers may develop, specifically in the milk ducts and the milk lobules. These ducts and lobules are located in all parts of the breast tissue, including tissue just under the skin. The breast tissue extends from the collar bone to the lower rib margin, and from the middle of the chest, around the side and under the arm.
In a mastectomy, it is necessary to remove tissue from just beneath the skin down to the chest wall and around the borders of the chest. However, even the most experienced surgeon cannot remove all breast tissue. This is why a small risk of developing breast cancer remains.
Who should have surgery?
The decision to proceed with prophylactic mastectomy is an individual decision. Such factors as a genetic predisposition to breast cancer, an estimation of individual’s breast cancer risk, the ability to monitor the patient for early breast cancer and, most importantly, the patient’s concerns and feelings, need to be considered in making this decision.
New developments broaden surgical options
For women who choose prophylactic mastectomy, several new and important surgical options have become available.
It is now possible to remove breast tissue using skin-sparing techniques in which the underlying breast tissue is removed from just under the skin and down to the chest wall. Most of the breast tissue is removed, but most of the skin is spared to hold and shape the reconstructed breast. The nipple and surrounding tissue, called the areola, are removed as well.
When skin-sparing mastectomy is combined with immediate breast reconstruction, the results can be excellent. Women who choose prophylactic mastectomy, often combined with immediate reconstruction, are very pleased not only with their choice but also with the reconstruction.
Nipple sparing mastectomy is another type of skin-sparing procedure that allows a woman to retain her own areola and nipple. During the surgery, the tissue beneath the nipple is tested and if normal, the nipple is kept, but loses sensation. The appearance of the breast after surgery is more similar to the appearance before surgery.
While surgery is not an approach that should be advocated for all high-risk individuals, it can be very important for appropriately selected women.
- National Cancer Institute. Preventive Mastectomy. www.cancer.gov Accessed 5/14/2012
- Society of Surgical Oncology. Practice & Policy: Position Statement on Prophylactic Mastectomy. www.surgonc.org Accessed 5/14/2012
- Breastcancer.org. Treatments & Side Effects: Surgery: Prophylactic Mastectomy. www.breastcancer.org Accessed 5/14/2012
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 4/1/2012...#8322