Preventive Mastectomy: Questions and Answers

Overview
  • Preventive mastectomy is the surgical removal of one or both breasts. It is done to prevent or reduce the risk of breast cancer in women who are at high risk of developing the disease.
  • Existing data suggest that preventive mastectomy may significantly reduce the chance of developing breast cancer in moderate-and high-risk women.
  • It is important for a woman who is considering preventive mastectomy to talk with a doctor about her risk of developing breast cancer, the surgical procedure and its potential complications, and alternatives to surgery.
  • Many women who choose to have preventive mastectomy also decide to have breast reconstruction to restore the shape of the breast.
  1. What is preventive mastectomy, and what types of procedures are used in preventive mastectomy?
  2. Preventive mastectomy is the surgical removal of one or both breasts in an effort to prevent or reduce the risk of breast cancer. Preventive mastectomy involves one of two basic procedures: total mastectomy and subcutaneous mastectomy. In a total mastectomy, the doctor removes the entire breast and nipple. In a subcutaneous mastectomy, the doctor removes the breast tissue but leaves the nipple intact. Doctors most often recommend a total mastectomy because it removes more tissue than a subcutaneous mastectomy. A total mastectomy provides the greatest protection against cancer developing in any remaining breast tissue.

  3. Why would a woman consider undergoing preventive mastectomy?
  4. Women who are at high risk of developing breast cancer may consider preventive mastectomy as a way of decreasing their risk of this disease. Some of the factors that increase a woman’s chance of developing breast cancer include the following:

    It is important for a woman who is considering preventive mastectomy to talk with a doctor about her risk of developing breast cancer, the surgical procedure, and potential complications. All women are different, so preventive mastectomy should be considered in the context of each woman’s unique risk factors and her level of concern.

  5. How effective is preventive mastectomy in preventing or reducing the risk of breast cancer?
  6. Existing data suggest that preventive mastectomy may significantly reduce the chance of developing breast cancer in moderate-and high-risk women. However, no one can be certain that this procedure will protect an individual woman from breast cancer. Breast tissue is widely distributed on the chest wall, and can sometimes be found in the armpit, above the collarbone, and as far down as the abdomen. Because it is impossible for a surgeon to remove all breast tissue, breast cancer can still develop in the small amount of remaining tissue.

  7. What are the possible drawbacks of preventive mastectomy?
  8. Like any other surgery, complications such as bleeding or infection can occur. Preventive mastectomy is irreversible and can have psychological effects on a woman, due to a change in body image and loss of normal breast functions. A woman should discuss her feelings about mastectomy as well as alternatives to surgery with her health care providers. Some women obtain a second medical opinion to help with the decision.

  9. What alternatives to surgery exist for preventing or reducing the risk of breast cancer?
  10. Doctors do not always agree on the most effective way to manage the care of women who have a strong family history of breast cancer and/or have other risk factors for the disease. Some doctors may advise very close monitoring to increase the chance of detecting breast cancer at an early stage. Some doctors may recommend preventive mastectomy, while others may prescribe tamoxifen, a medication that has been shown to decrease the chances of getting breast cancer in women at high risk of the disease. Doctors may also encourage women at high risk to limit their consumption of alcohol, eat a low-fat diet, engage in regular exercise, and avoid menopausal hormone use. Although these lifestyle recommendations make sense and are part of an overall healthy way of living, we do not yet have clear and convincing proof that they specifically reduce the risk of developing breast cancer.

  11. What is breast reconstruction?
  12. Breast reconstruction is a plastic surgery procedure in which the shape of the breast is rebuilt. Many women who choose to have preventive mastectomy also decide to have breast reconstruction, either at the time of the mastectomy or at some later time.

    Before performing breast reconstruction, the plastic surgeon carefully examines the breasts and discusses the reconstruction options. In one type of reconstructive procedure, the surgeon inserts an implant under the skin and the chest muscles. Another procedure, called tissue flap reconstruction, uses skin, fat, and muscle from the woman’s abdomen, back, or buttocks to create the breast shape. The surgeon will discuss with the patient any limitations on exercise or arm motion that might result from these operations.

  13. What type of follow-up care is needed after reconstructive surgery?
  14. Women who have reconstructive surgery are followed carefully to detect and treat complications, such as infection, movement of the implant, or contracture. Women who have tissue flap reconstruction may want to ask their surgeon about physical therapy, which can help them adjust to limitations in activity and exercise after surgery. Routine screening for breast cancer is also part of the postoperative follow-up, because the risk of cancer cannot be completely eliminated. When women with breast implants have mammograms, they should tell the radiology technician about the implant. Special procedures may be necessary to improve the accuracy of the mammogram and to avoid damaging the implant. However, women who have had reconstructive surgery on both breasts should ask their doctors whether mammograms are still necessary.

  15. Where can a person find more information about breast implants?
  16. The U.S. Food and Drug Administration regulates the use of breast implants and can supply detailed information about these devices. To listen to recorded information or request free printed material on breast implants, consumers can contact the FDA Center for Devices and Radiological Health at:

    Address:

    Consumer Staff
    CDRH/FDA
    HFZ–210
    1350 Piccard Drive
    Rockville, MD 20580

    Telephone:

    1–888–INFO–FDA, toll-free 301–827–3990

    E-mail:

    dsma@cdrh.fda.gov

    Web site:

    http://www.fda.gov/cdrh/consumer/index.shtml http://www.fda.gov/cdrh/breastimplants

 

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