What Is a Bilateral Mastectomy?

A bilateral mastectomy is the removal of both breasts, a surgery typically performed to treat women suffering from breast cancer or as a preventative treatment for women who have a high risk of getting breast cancer. The patient is put under general anesthesia as the surgeon removes all of the breast tissue, often including the nipple and skin, and sometimes part of the chest muscle. During surgery, surgeons will also check the lymph tissue of the armpit for cancer in women who suffer from particularly aggressive cancers. While a mastectomy greatly reduces the risk that the cancer will return or occur in the first place, no surgeon can reduce a patient’s cancer risk to zero.

Preventative, or prophylactic, mastectomies are becoming more common as doctors improve their understanding of cancer genetics. Women who already have cancer in one breast are also choosing to have both breasts removed to prevent recurrence of the disease. A woman who chooses to have a bilateral mastectomy before getting breast cancer can have her breasts reconstructed at the same time. In these cases, a skin-saving mastectomy may be used to preserve the skin for reconstruction. Breast tissue is removed from an incision made around the areola.

Like all surgeries, a bilateral mastectomy does have risks, including bad reactions to anesthesia, infections, and poor body image after surgery. If a woman chooses to reconstruct her breasts, there are risks associated with implants, such as hardening of the area around the implant, rupturing of the implant, and migration of the implant. Women who choose to have a bilateral mastectomy may want to participate in a support group to help them address these risks.

Some women decide not to have reconstructive surgery after having a bilateral mastectomy. These women are first fitted with a tube that drains fluid from the surgical wound. When the wound heals, they may choose to use prosthetic breasts made from silicone gel or other materials. These can be worn on the skin or inside the pocket of a modified bra.

Women should expect to stay in the hospital for at least one day following a mastectomy and a day or two longer if they opt for reconstruction. Insurance coverage for bilateral mastectomies and associated reconstructions or prostheses varies. Women seeking to prevent cancer through a bilateral mastectomy should check their insurance’s policy and local laws for coverage.