Preventative breast reconstruction

Preventative (prophylactic) mastectomy is surgical removal of the breasts in women who don’t have breast cancer.

You may consider having a preventative mastectomy if you have a strong family history of breast cancer and/or if genetic testing suggests a strong likelihood that you may be diagnosed with breast cancer in the future. Preventative mastectomy is a big decision. It involves much consideration, consultation with healthcare professionals and genetic counseling.

Most women decide to have a breast reconstruction at the same time as the preventative mastectomy. Still, other women don’t feel ready to make that commitment. Some women find that factors such as financial issues, family situation or access to services mean that an immediate breast reconstruction is not right for them.

If you choose to have a mastectomy without breast reconstruction, the surgeon will remove the breast skin, areola and nipple. If you decide to have a breast reconstruction later, the remaining skin may need to be stretched to accommodate a breast shape. Alternatively, skin and tissue from another part of the body can be used to replace the skin that’s been removed surgically.

PHYSICAL APPEARANCE FOLLOWING PREVENTATIVE MASTECTOMY

If you are having a preventative mastectomy, it is usually possible to preserve the skin over the breast, the areola and the nipple. Breast reconstruction following preventative mastectomy will usually involve replacing the underlying tissue only. This means that the reconstructed breasts are likely to look similar to the original breasts. There may be some differences in shape and feel, depending on the type of breast reconstruction. Having both breasts reconstructed means they are more likely to be symmetrical.

WHO IS PREVENTATIVE MASTECTOMY FOR?

All women are at risk of breast cancer just by being female and advancing in age. But some factors increase your risk significantly. You may consider preventative mastectomy if you have:

Already had cancer in one breast

If you develop breast cancer and have a strong family history of the disease, you may decide to have both breasts removed. One breast is removed to get rid of the cancer, and the other, unaffected breast is removed to greatly reduce the possibility of developing another breast cancer in the future.

A family history of breast cancer

If you have a mother, sister or daughter with breast cancer, especially if she was diagnosed before age 50, you may be at an increased risk of developing breast cancer. If you have multiple family members with breast cancer or ovarian cancer, your risk of breast cancer may be greater. A predisposition to breast cancer can be passed on to you through your mother’s or father’s side of the family.

Positive results from gene testing

Genetic testing can identify if you have mutations in genes that increase your risk of breast cancer or other cancers such as ovarian cancer. Genes known to increase the risk of breast and ovarian cancers include BRCA1 and BRCA2. If you have a strong family history of breast cancer, you may consider meeting with a genetic counselor to discuss genetic testing.

Breast changes that increase your risk of breast cancer

Your doctor may have discovered abnormal cells in the milk-producing glands of your breast. This finding is not cancer, but is a marker of an increased risk of developing breast cancer in both breasts.

Radiation therapy

If you had radiation therapy to your chest before age 30, you have an increased risk of developing breast cancer.

Dense breasts

Dense breast tissue is associated with breast cancer, and it makes it harder for doctors to diagnose breast cancer. In certain cases, a woman with dense breasts may consider a preventative mastectomy, especially if she has other risk factors, such as a strong family history of breast cancer or precancerous conditions.

Your doctor determines whether you’re at high risk of breast cancer based on your risk factors and on mathematical models that calculate your lifetime risk of breast cancer.