In hopes of avoiding cancer, some high-risk women elect to have both breasts surgically removed, a procedure called bilateral prophylactic mastectomy. The surgery would remove 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 same or other breast.
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.
Is preventative mastectomy effective?
In reviewing past studies of prophylactic mastectomy, results vary widely. In some studies, women had prophylactic mastectomies for a variety of reasons, such as pain, fibrocystic breast disease, dense breast tissue, cancer phobia, or a family history of breast cancer. Some women still developed breast cancer even though they had their breast tissue removed. But, in most studies, patients did not develop breast cancer after prophylactic mastectomy. However, many of these patients would not have been predicted to have had a high-risk cancer development.
There have been arguments made that even for high-risk women, prophylactic mastectomy is inappropriate because not all breast tissue can be removed during a surgical procedure. To understand why, we need to know what composes breast tissue and from where cancer comes.
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 with very thorough and delicate surgical techniques, it is impossible to remove every milk duct and lobule, given the extent of the breast tissue and the location of these glands just beneath the skin.
Who should have surgery?
Does this mean that every patient should be considered for breast cancer prevention surgery? The answer is clearly no. The decision to proceed with prophylactic mastectomy is an individual decision. Such factors as an estimation of individual 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.
Prophylactic mastectomy should only be considered after you’ve received the appropriate genetic and psychological counseling to discuss the psychosocial effects of the procedure.
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. This technique removes the vast majority of the glands where breast cancer may be more likely to develop. The nipple and surrounding tissue, called the areola, are also removed because the ducts converge toward the nipple, creating a concentrated area of duct tissue. However, the skin of the breast is spared, preserving the breast skin envelope.
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.
While surgery is not an approach that should be advocated for all high-risk individuals, it can be very important for appropriately selected women.
© Copyright 1995-2009 The Cleveland Clinic Foundation. All rights reserved.
Can't find the health information you’re looking for?
Ask a Health Educator, Live!
Know someone who could use this information?...send them this link.
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: 2/26/2007...#8322
