A hot topic among members of my online breast cancer support groups is whether to also remove the healthy breast when having a mastectomy. A double mastectomy can help with symmetry and balance. But many of my friends view the procedure as a way to prevent cancer from spreading to the other side, or to prevent a new cancer.
Statistically, the risk of developing cancer in the second breast is very low for most women, as low as one per cent. Yet between 1998 and 2011, the rate of bilateral surgery increased from around 2 percent among all women undergoing mastectomy to 11 percent.
E. Shelley Hwang and other researchers at the Duke University Comprehensive Cancer Center compared the experiences of 1,598 women with breast cancer who had a prophylactic mastectomy on their healthy breast to a group of 2,379 patients who underwent a single mastectomy.
Several years after their surgery, the volunteers were asked to fill out a survey that measured their psychological, physical and sexual well-being. The researchers also gauged the women’s overall satisfaction with their breasts by asking how the women felt about their appearance, fit in a bra and related issues.
The well-being scores turned out to be quite mixed. Patients who had reconstruction reported higher breast satisfaction but lower physical and psychological well-being than women who had only one breast removed. Those who had radiation or surgical complications were overall less satisfied with their surgery. The researchers concluded that while there was some benefit to undergoing double surgery, it wasn’t significant enough to be “clinically meaningful.”
The study was conducted prior to the recent increase in bilateral mastectomies due to the “Angelina Jolie effect.” Participants were mostly in their fifties, so although the research didn’t ask about BRCA mutation status, it is unlikely that there were many BRCA mutation carriers.
If you are considering a prophylactic mastectomy, here are a few things to keep in mind:
- Removing a healthy breast is not medically necessary so don’t make this decision based on fear of cancer spreading without accurate information. BRCA mutation carriers and women with lobular breast cancer do have a higher risk of developing cancer in the healthy breast. First find out just how likely it is that you might develop another cancer.
- Bear in mind your tolerance for pain. Up to a third of women had chronic pain following mastectomy so the procedure carries some risk. The women who were happiest with their double mastectomy were those who also had reconstruction surgery, a process requiring multiple surgeries, which can be uncomfortable and sometimes quite painful.
- Consider how important your breasts are when it comes to your sex life. A reconstructed breast will not have stimulatory sensation. Leaving one healthy breast could allow you and your partner to have a happier sex life.
- Think about symmetry and balance. The women I know who regret having a single mastectomy the most are those who have trouble finding a comfortable prosthesis and clothes that fit. Those with large breasts often report shoulder pain and problems related to the lack of balance.
- Ask your doctors all the necessary questions. Often times, it’s the patient who asks for the surgery since it is unusual for a doctor to recommend it. Make sure you understand the possible complications and see what your oncologist and radiation oncologist think. They will have opinions about how possible complications could affect your chemotherapy and/or radiation treatments.
- Whatever you decide, don’t second guess yourself. No one else has to live in your body but you. With the available information, you will have made the best decision for you.
See More Helpful Articles:
Bath, C. Quality-of-Life Benefits of Contralateral Prophylactic Mastectomy May Be Too Small to Be Clinically Meaningful. The ASCO Post. April 25, 2016. Accessed online at https://www.ascopost.com/issues/april-25-2016/quality-of-life-benefits-of-contralateral-prophylactic-mastectomy-may-be-too-small-to-be-clinically-meaningful/?utm_medium=Email&utm_source=ExactTarget&utm_campaign&utm_term=5405826 June 11, 2016.
Hwang, E. S., et al. Patient-Reported Outcomes After Choice for Contralateral Prophylactic Mastectomy. Journal of Clinical Oncology. March 7, 2016. Accessed from https://jco.ascopubs.org/content/34/13/1518 June 14, 2016.
Phyllis Johnson is an inflammatory breast cancer survivor who serves on the Board of Directors for theInflammatory Breast Cancer Research Foundation, the oldest 501(3)© organization focused on research for IBC. She is a list monitor for an online support group atwww.ibcsupport.org. She stays current on cancer information through attendance at conferences such as the National Breast Cancer Coalition’s Project LEAD® Institute. A retired teacher, she has been writing about cancer issues at HealthCentral since 2007.
Phyllis Johnson is an inflammatory breast cancer (IBC) survivor diagnosed in 1998. She has written about cancer for HealthCentral since 2007. She serves on the Board of Directors for the Inflammatory Breast Cancer Research Foundation, the oldest 501(3)© organization focused on research for IBC. She is a list monitor for an online support group at www.ibcsupport.org. Phyllis attends conferences such as the National Breast Cancer Coalition’s Project LEAD® Institute. She tweets at @mrsphjohnson.