Preventive mastectomy is a controversial subject. Preventive mastectomy (also called prophylactic mastectomy) is surgery to remove one or both breasts of women who have strong risk factors for breast cancer but no evidence of the disease.
The surgery may involve removing the entire breast (total mastectomy) or removing just the breast tissue but not the skin and nipple (subcutaneous mastectomy). After either procedure, the patient may decide to have breast reconstruction - plastic surgery to restore the shape of the breast.
This procedure may be appropriate for women who have had certain types of breast cancer because they are at risk of developing breast cancer again - in the same and/or the opposite breast.
It also may be recommended for women whose breast tissue is so dense that physical examination or mammography is difficult, necessitating multiple biopsies, which in turn cause tissue scarring and further complicates examination of breast tissue.
However, doctors do not agree on the most effective way of managing the care of women who have a strong family history of breast cancer and have certain other risk factors for the disease. Some recommend preventive mastectomy, while the majority recommend very close observation (monthly breast self-examination, checkups every 3 months and periodic mammograms) instead.
In addition, doctors are concerned that women who have preventive surgery may have a false sense of security. Some patients mistakenly believe that the operation is a complete guarantee against breast cancer. However, it is almost impossible to remove all breast tissue with any type of mastectomy, and breast cancer may develop in any remaining tissue. There is no definitive evidence to prove that a prophylactic mastectomy reduces a woman's chance of getting breast cancer.
Because women differ, the use of preventive mastectomy should be considered in the context of each woman's unique risk factors as well as her feelings about mastectomy and breast reconstruction. A woman considering preventive mastectomy should discuss her risk factors, the mastectomy procedure, the likely outcome of reconstructive surgery, potential complications, and follow-up care with her doctor and plastic surgeon. She should also get a second opinion.
What are the risk factors for developing breast cancer?
Would routine screening and observation suffice?
What are the advantages and disadvantages of surgery?
Which surgical procedure do you recommend?
Would surgery substantially reduce the risk of developing breast cancer?