FAQs on Preventive Double Mastectomy

Cancer Preventing Lifestyle Changes

What is a preventive double mastectomy and why it is required?

To avoid the occurrence of breast cancer in future, some women who are at very high risk of developing it, elect to have both breasts surgically removed (bilateral prophylactic mastectomy or preventive mastectomy). The surgery is aimed at removing all breast tissue that potentially could develop breast cancer later in life.

Who Should Have a Preventive Mastectomy?

According to the Society of Surgical Oncology, USA, women who are at very high risk of breast cancer should consider prophylactic or preventive mastectomy post their genetic testing. This includes women with one or more of the following risk factors:

  • Mutated BRCA genes
  • A strong family history of breast cancer
  • Previous cancer in one breast
  • History of lobular carcinoma in situ (LCIS)

Preventive mastectomy should only be considered after receiving the appropriate genetic and psychological counselling to discuss the aesthetic and psychosocial impacts of the procedure.

What are BRCA genes?

The risk factor of getting a breast cancer for a woman can be decided by some tests that detect the genetic mutation within certain genes, BRAC1 and BRAC2, which are tumour suppressing genes. Mutation (alteration) in these genes has been linked to breast and ovarian cancer. A female’s lifetime risk of developing breast and/or ovarian cancer gets highly increased if she inherits a harmful BRCA1 or BRCA2 mutation.

Is there a test available to check the genes and how it is done?

Yes, it can be done through gene testing. A blood sample is taken for these tests and sent to a laboratory that specializes in gene testing. It usually takes several weeks or even longer to get the final test reports.

Genetic counselling is highly recommended before and after a genetic test. It usually involves a risk assessment based on the inpidual’s personal and family medical history, the medical implications of a positive or a negative test result, the psychological risks and benefits of genetic test results and the risk of passing a mutation to children.

Does the whole breast need to be removed for preventive mastectomy?

In the case of preventive or prophylactic mastectomy, either a total mastectomy is done where the entire breast tissue, areola, nipples, lymph nodes in the armpit and the chest muscles are removed or a nipple sparing mastectomy can be performed where tissue within the breast is removed but the skin, chest muscles and the nipple are kept intact. This call is taken by the operating surgeon looking at the test reports and medical as well as family history of the patient.

After the removal of breast tissue patient can opt for a reconstructive breast surgery.

What is breast reconstruction?

Breast reconstruction is a plastic surgery procedure in which the shape of the breast is rebuilt, once the inside breast tissue is removed. Purely for aesthetic reasons, women who undergo preventive mastectomy also decide to have a breast reconstruction done, either at the time of the mastectomy or else at some later time.

How much the risk of getting a breast does gets reduced post preventive mastectomy?

As the existing data suggests, it reduces the chances of getting breast cancer in high risk population to up to 90% in moderate and high-risk women. However, no one can be certain that this procedure will protect an inpidual from breast cancer with certainty, lifelong.