Preventive mastectomy (also called prophylactic or risk-reducing mastectomy) is the surgical procedure during which one or both breasts are removed in an effort to prevent or reduce the risk of breast cancer.
There are two basic procedures:
- Total mastectomy - in which the doctor removes the entire breast tissue and nipple
- Subcutaneous mastectomy - in which the doctor removes the breast tissue but leaves the nipple intact
Doctors mostly recommend a total mastectomy because it provides the greatest protection against cancer developing in any remaining breast tissue.
The preventive mastectomy can by about 90% reduce the chance of developing breast cancer in moderate- and high-risk women, but no one can be certain that this procedure will protect a woman from breast cancer because breast cancer can still develop in the small amount of remaining tissue in the armpit, above the collarbone, and as far down as the abdomen.
Preventive mastectomy should be considered by women who are at high risk of developing breast cancer. These are women who previously had breast cancer in one breast, women with lobular carcinoma in situ, a women who has diffuse and indeterminate breast microcalcifications (tiny deposits of calcium in the breast) or for a women whose breast tissue is very dense, women who had radiation therapy to the chest (including the breasts) before age 30 and women with family history of breast cancer and women who test positive on genetic tests for breast cancer.
Some doctors do suggest a preventive mastectomy but some doctors advise very close monitoring (periodic mammograms, regular checkups that include a clinical breast examination performed by a health care professional, and monthly breast self-examinations) and some can prescribe medications that have been shown to decrease the chances of getting breast cancer in women at high risk of the disease (tamoxifen or raloxifene).
After a preventive mastectomy, many women choose to have breast reconstruction to rebuild the shape of the breast by inserting an implant under the skin and the chest muscles.
Also, a flap reconstruction procedure can be performed by using the skin, fat, and muscle from woman’s abdomen, back or buttocks to create the breast shape.
The first few days after surgery, the patient may experience some discomfort, but women will be given pain medication as needed. Soon after surgery, she will be encouraged to move her arms, but not for any forceful activity such as pulling herself up, getting out of bed or lifting heavy objects.
The length of the hospital stay depends on the type of operation and how recovery progresses. The average length of hospitalization is one to two days for the implants and five to six day to flap procedures.
Most women return to normal activities within six weeks after surgery. It may be several weeks before strenuous exercise. Most scars will fade over time and the shape of reconstructed breast will gradually improve over the months following the reconstruction.
The risk of cancer cannot be completely eliminated so women must continue with screening for breast cancer, but the doctor will if the mammogram is still necessary.