Prophylactic (Preventive) Mastectomy

A prophylactic mastectomy is surgery to remove one or both of your breasts to lower your risk of breast cancer. You may also hear it called a “preventive mastectomy” or “risk-reducing mastectomy.” “Prophylactic” means something that helps prevent disease.

Your healthcare provider may suggest this surgery if you have a very high risk of breast cancer. You may have a harmful change in a gene, like BRCA1 or BRCA2. Or you may have a strong biological family history of breast cancer.

A prophylactic mastectomy greatly lowers your risk of breast cancer. But it can’t prevent all cases. It isn’t always possible to remove every breast cell during surgery. Cancer could form in the small amount of breast tissue left behind.

Why is a prophylactic mastectomy done?

You may consider a prophylactic mastectomy if you have:

• A change (variant) in a gene linked to breast cancer, like BRCA1 or BRCA2
• A strong family history of breast cancer
• A first-degree relative (mother, sister, daughter) who developed breast cancer at a young age
• A history of radiation therapy to your chest before age 30
• Certain types of lobular carcinoma in situ (LCIS) along with a strong family history
• Cancer in one breast and a high risk of cancer in the other

Before you decide, your provider may suggest a breast cancer risk assessment. This looks at your family history, personal health history and other risk factors.

They may also suggest genetic counseling and testing. A genetic counselor can explain what your test results mean for you and your family.

Providers usually won’t recommend a prophylactic mastectomy if you have an average or slightly higher risk of breast cancer. Other ways to lower or manage your risk include:

• Getting more frequent breast cancer screenings
• Starting screenings at a younger age
• Having breast MRIs along with mammograms
• Taking medicine that lowers breast cancer risk

Your provider can explain which options may be right for you.

What are the benefits of prophylactic mastectomy?

The main benefit is a much lower risk of breast cancer. Having both breasts removed reduces the risk by:

• At least 95% in people with a harmful BRCA1 or BRCA2 gene change
• Up to 90% in people with a strong family history of breast cancer

But the surgery doesn’t lower your risk to zero. It also may not help everyone live longer. Your age, health and personal cancer risk all affect how much you may benefit.

What are the risks of prophylactic mastectomy?

Like any major surgery, a prophylactic mastectomy has risks. These include:

• Bleeding
• Infection
• Blood or fluid buildup near the surgical area
• Slow wound healing
• Pain
• Scarring
• Loss of feeling in your breast or nipple
• Problems with breast reconstruction

The surgery causes permanent changes to your body. It may affect how you feel about your body or your sex life. You also won’t be able to breastfeed.

Many people are happy with their choice to have surgery. But you may still have concerns about your body or feel anxious after the procedure. It can help to discuss these feelings with your care team or a mental health specialist.

What are the types of prophylactic mastectomy?

Your healthcare provider may describe the surgery in a couple of ways:

• Bilateral prophylactic mastectomy: This type removes both breasts before cancer develops. It’s also called a prophylactic double mastectomy.
• Contralateral prophylactic mastectomy: If you’re having one breast removed to treat cancer, you may choose to have your other, healthy breast removed at the same time.

Your surgeon will also help you choose how the breast tissue is removed. Prophylactic mastectomy options include:

• Total or simple mastectomy
• Skin-sparing mastectomy
• Nipple-sparing mastectomy

Not everyone can have a skin-sparing mastectomy or nipple-sparing mastectomy. Your surgeon will help you choose the safest option.

What happens before a prophylactic mastectomy?

You’ll talk with your healthcare provider about your breast cancer risk. They’ll explain the possible benefits and risks of surgery. They’ll also discuss other ways to lower or manage your risk.

You’ll also decide if you want breast reconstruction. Reconstruction is surgery that creates a new breast shape. You may have it during the mastectomy or at a later time.

Your healthcare team will tell you how to prepare for surgery. Follow their directions about food, drinks and medicines.

What happens during a prophylactic mastectomy?

First, you’ll get anesthesia. This medicine puts you to sleep so you won’t feel pain during surgery.

Then, your surgeon will:

1. Make one or more cuts (incisions) in your skin.
2. Remove as much breast tissue as possible.
3. Remove your skin, areola or nipple, depending on the type of mastectomy you have.
4. Place thin tubes called drains under your skin (these carry extra fluid away from the surgical area while you heal).

If you’ve chosen immediate reconstruction, a plastic surgeon will start it during the same operation.

How long the surgery takes depends on:

• Whether you have one or both breasts removed
• The type of mastectomy
• Whether you have reconstruction
• The type of reconstruction you choose

Your surgeon can tell you how long they expect the procedure to take.

What happens after a prophylactic mastectomy?

Your healthcare team will monitor you as you wake up from anesthesia. They’ll give you medicine for pain or nausea if you need it.

Your hospital stay depends on the type of surgery you have. You may need a longer stay if you have breast reconstruction.

Before you go home, your care team will explain how to:

• Care for your surgical incisions
• Care for your drains
• Manage pain
• Bathe safely
• Move your arms safely
• Watch for signs of infection or other problems

A lab will check the removed breast tissue for cancer. Sometimes, these tests find cancer that earlier exams didn’t detect. Your provider will explain the results and tell you if you need more care.

What is prophylactic mastectomy recovery like?

Recovery from mastectomy is different for everyone. It depends on the type of procedure and whether you have breast reconstruction.

After surgery, you may have:

• Pain or soreness
• Swelling
• Bruising
• Numbness
• Tightness across your chest
• Trouble moving your arms or shoulders

These problems should improve as you heal. But some loss of feeling may be permanent.

Recovery often takes several weeks. It may take a few months if you also have reconstruction. Some types of reconstruction require more than one surgery.

Your provider will tell you when it’s safe to drive, return to work or do physical activity. Ask them when you can lift heavy objects or do activities that use your upper body.

What follow-up care will I need?

You’ll have follow-up visits with your care team. They’ll check how you’re healing and remove your drains when you no longer need them.

Your healthcare provider may recommend gentle arm and shoulder exercises. These exercises can help prevent stiffness and improve movement. You may work with a physical therapist if you have pain, weakness or trouble moving.

After both breasts are removed, you usually won’t need regular mammograms. But you should keep an eye out for any changes in your chest, skin or scars.

Your emotional recovery may take time, too. Your chest may look and feel different after surgery. Talking with a counselor, support group or someone else who’s had the surgery may help.

When should I call my healthcare provider?

Call your provider if you have:

• A fever
• Pain that’s getting worse
• New or increasing redness, warmth or swelling
• Pus or a bad-smelling fluid from your surgical cut
• Heavy bleeding
• A surgical cut that opens
• Sudden swelling in your chest
• Problems with a drain
• New swelling or weakness in your arm

Get emergency care if you have chest pain or trouble breathing.