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A prophylactic mastectomy is a surgery performed to remove breast tissue in the hopes of reducing the likelihood of breast cancer. In most cases, only women who are in exceptionally high-risk groups for developing cancer choose this surgery. Usually the mastectomy is bilateral and both breasts, in addition to surrounding tissue that could include small amounts of breast tissue in the armpits and chest wall, are surgically removed. At this point, women may opt for breast reconstructive surgery, though reconstruction might slightly obscure cancerous cells in the post-mastectomy chest region.
Making the decision to have a prophylactic mastectomy is difficult and physicians support it if certain risk factors are in place. This includes findings of precancerous cells that may indicate developing cancer is more likely. Some women have very dense breast tissue that poses an increased risk for cancer and due to its density, is more likely to delay cancer diagnosis. Other factors that could influence the decision to have this surgery include a strong family history of breast cancer in family members who are under the age of 50, higher genetic risk, or radiation treatment before the age of 30.
Although a prophylactic mastectomy is typically depicted as a radical step, this isn’t always the case. Many women have a bilateral mastectomy when cancer is found in only one of the breasts. It may not be necessary to remove the breast that is unaffected, but it could be recommended as a better method for fighting a recurrence of breast cancer. Similarly, any woman undergoing gender reassignment therapy would have a bilateral mastectomy, though in these cases the main goal isn’t cancer prevention.
The intent of a prophylactic mastectomy is to reduce the risk of cancer, and results of these surgeries tend to justify the procedure. About nine in ten women who choose this treatment don’t develop breast cancer. The results aren’t perfect because it’s hard to eliminate all breast tissue and approximately 10% of women may still develop cancer in the remaining or hard to find breast tissue that wasn’t removed.
Women who feel reluctant to consider this preventative method have other options. They may reduce risk and include regular screening, certain drugs that have been shown effective against cancer cells, and lifestyle changes. These are not as effective as prophylactic mastectomy, but may be a good middle of the road solution for some patients.
Many women have reconstructive surgery after prophylactic bilateral mastectomy. This could use implants or fat and muscle collected from other areas of the body to restore breast shape. Some women don’t choose reconstruction due to continued concerns about the ability to screen for remaining cancer.
It is emotionally challenging to undergo any extreme physical change, and especially, removal of the breasts. In addition to the medical treatment provided by doctors, many women benefit from supportive counseling before and after surgery. At minimum, it’s recommended that women seek counseling prior to having a prophylactic mastectomy, so they can make a clear and informed decision about whether to undergo it.