Prophylactic (Preventative) Mastectomy

What is a prophylactic mastectomy?

Prophylactic mastectomy is a surgery to remove one or both breasts. It reduces your risk of developing breast cancer.

Your healthcare provider may recommend a prophylactic mastectomy if you have a high risk of developing breast cancer. Other names for prophylactic mastectomy include preventative mastectomy or risk-reducing mastectomy.

Who may choose to have a prophylactic mastectomy?

You may choose to have a preventative mastectomy if you have risk factors for developing breast cancer, such as:

• Family history of breast cancer: Your risk increases significantly if an immediate family member, such as your mother, daughter or sister, had breast cancer. Your risk is even higher if that family member had breast cancer before age 50.
• Personal history of breast cancer: If you already have breast cancer in one breast and need a mastectomy, you may choose to remove the other breast. This, however, doesn’t change your prognosis or indications for additional therapy to treat your breast cancer.
• Positive genetic testing results: Genetic testing looks for gene changes (mutations), such as in the BRCA1 or BRCA2 genes. If you test positive for these mutations, you may choose to have a prophylactic mastectomy.
• Radiation therapy: A history of radiation therapy to your chest, particularly between ages 10 and 30, increases your risk of breast cancer.

Why is a prophylactic mastectomy done?

Healthcare providers use prophylactic mastectomies to reduce breast cancer risk. A prophylactic mastectomy can decrease the risk of developing breast cancer by:

• 95% for people with a BRCA1 or BRCA2 gene mutation.
• 90% for people with a strong family history of breast cancer.

What are the types of prophylactic mastectomy?

There are several types of prophylactic mastectomy:

• Bilateral (double) mastectomy removes both breasts.
• Contralateral mastectomy removes the healthy breast in people who have cancer in the other breast.
• Skin-sparing mastectomy removes the nipple and areola, then removes breast tissue through that small incision.
• Nipple-sparing mastectomy removes only breast tissue without touching the nipple or areola.
• Double mastectomy with reconstruction removes both breasts and reconstructs them using implants or tissue from another area of your body.

What happens before a prophylactic mastectomy?

Your healthcare provider will give you instructions to prepare for a prophylactic mastectomy. You usually don’t need to do anything different than usual.

On the day of surgery, you change into a hospital gown. Then, a healthcare provider attaches an intravenous (IV) line to your hand or arm. The IV contains medication (anesthesia) so you relax and remain asleep during the procedure. You're then brought to the operating room for your procedure.

What happens during a prophylactic mastectomy?

During a prophylactic mastectomy, a breast surgeon:

1. Makes an incision in your breast.
2. Separates your breast tissue from your skin and chest muscles.
3. Removes your breast tissue and begins reconstruction if that is part of your surgical plan.
4. Inserts long tubes (drains) in your breast to drain excess fluid during healing.
5. Stitches the incision closed and covers the area with a bandage.

A prophylactic mastectomy usually takes around two to three hours. Surgery will last longer if you’re having breast reconstruction at the same time.

What happens after a prophylactic mastectomy?

You may stay in the hospital overnight after a prophylactic mastectomy. Your exact length of stay depends on several factors, including your overall health and whether you also had a reconstruction.

After surgery, a healthcare provider will teach you exercises to decrease stiffness in your arms or shoulders. These exercises reduce how much scar tissue forms. Your surgical team gives you instructions to care for yourself at home before you leave the hospital.

What are the advantages of a prophylactic mastectomy?

If you have multiple breast cancer risk factors, a prophylactic mastectomy significantly reduces your risk of developing breast cancer.

However, prophylactic mastectomy doesn’t benefit people with an average risk of developing breast cancer. The pros and cons of a prophylactic mastectomy vary depending on your personal risk profile.

What are the risks or complications of a prophylactic mastectomy?

A prophylactic mastectomy has the risk of:

• Bleeding.
• Infection.
• Loss of sensation in your breast.

There’s also a risk of dissatisfaction with your body’s appearance after surgery. You may struggle with the psychological effects of losing one or both breasts.

Speak with a psychologist or other mental health provider if you have anxiety or concern about your body image. These professionals can help you cope with difficult emotions through healthy means, such as journaling, meditating or joining a support group.

What is the recovery time after a prophylactic mastectomy?

Recovery time after a mastectomy varies. Initial recovery takes about three to four weeks on average. Recovery may take up to eight weeks if you also had a breast reconstruction. It may be several months before you can resume all your usual activities.

When should I see my healthcare provider?

Call your healthcare provider after a prophylactic mastectomy if you experience:

• Bleeding.
• Fever.
• Pain that doesn’t improve after a few weeks.
• Redness or swelling that doesn’t go away.
• Warmth around your surgical incisions.

How painful is a prophylactic mastectomy?

Your chest and arms may feel painful for several weeks after a prophylactic mastectomy. Usually, you can manage pain with over-the-counter medicines. Call your healthcare provider if the pain worsens or doesn’t get better after a few weeks.

A note from Cleveland Clinic

A prophylactic mastectomy is a surgery to reduce your risk of breast cancer. You might be a candidate for the procedure if you have a high risk of breast cancer, such as a gene mutation or family history. During a prophylactic mastectomy, your surgeon removes one or both breasts. You may also have breast reconstruction using implants or your own tissue.