Prophylactic Mastectomy
A prophylactic mastectomy (also known as preventive mastectomy) is a surgical procedure where one or both breasts are removed to reduce the risk of developing breast cancer. This surgery aims at removing the breast tissue as completely as humanely possible to prevent cancer development.
It is important to note that this surgery is done in individuals who do not actually have any breast cancer. It is often chosen by individuals who are at a significantly high risk of breast cancer, such as those with a strong family history of the disease or those who carry certain genetic mutations like BRCA1 or BRCA2.
Types of Prophylactic Mastectomy:
1. Bilateral Prophylactic Mastectomy:
- This involves removing both breasts in women who have never had breast cancer but are at high risk of developing it in the future. This is commonly chosen by women with genetic mutations or a strong family history of breast cancer.
2. Contralateral Prophylactic Mastectomy:
- This is performed in women who have already been diagnosed with cancer in one breast and choose to have the healthy breast removed to reduce the risk of cancer developing in the other breast.
Who is a Candidate for Prophylactic Mastectomy?
1. BRCA1 and BRCA2 Gene Mutations:
- Women who carry mutations in the BRCA1 or BRCA2 genes have a significantly higher lifetime risk of developing breast cancer. Prophylactic mastectomy can reduce this risk by up to 90%.
2. Strong Family History:
- Individuals with multiple close relatives (mother, sister, or daughter) who have had breast cancer, especially at a young age, may consider this surgery.
3. Previous Radiation Therapy:
- Women who had radiation therapy to the chest (often for other cancers like Hodgkin’s lymphoma) before the age of 30 are at higher risk of breast cancer and may consider prophylactic mastectomy.
4. Other Genetic Mutations:
- Mutations in other genes like TP53 (Li-Fraumeni syndrome) or PTEN (Cowden syndrome) also increase the risk of breast cancer, and prophylactic mastectomy may be recommended.
5. Lobular Carcinoma in Situ (LCIS):
- Women diagnosed with LCIS, a non-invasive condition that increases breast cancer risk, might opt for preventive mastectomy.
Benefits:
- Risk Reduction: Prophylactic mastectomy can reduce the risk of developing breast cancer by approximately 90-95%, especially in high-risk women.
- Peace of Mind: Some women choose the surgery to alleviate the anxiety and emotional stress of living with a high risk of breast cancer.
Types of Surgery:
1. Total Mastectomy:
- In this procedure, the entire breast tissue, including the nipple-areola complex, is removed. This provides the most comprehensive risk reduction.
2. Nipple-Sparing Mastectomy (NSM):
- In some cases, especially in prophylactic mastectomies, the nipple-sparing mastectomy (NSM) can be performed, where the breast tissue is removed but the skin and nipple-areola complex are preserved for better cosmetic results.
3. Skin-Sparing Mastectomy (SSM):
- This involves removing the breast tissue but preserving most of the skin. Like NSM, it allows for a more natural-looking breast reconstruction.
Breast Reconstruction Options:
Many women undergoing prophylactic mastectomy opt for immediate breast reconstruction. Options for reconstruction include:
- Implant-Based Reconstruction: Using saline or silicone implants.
- Autologous Tissue Reconstruction: Using tissue from other parts of the body (such as the abdomen or back) to create a new breast.
Risks and Considerations:
1. Surgical Risks: As with any major surgery, there are risks such as infection, bleeding, or complications from anaesthesia.
2. Emotional Impact: Prophylactic mastectomy is a life-changing decision. It can bring emotional challenges, such as coping with body image changes.
3. Cancer Risk: While prophylactic mastectomy greatly reduces breast cancer risk, it does not eliminate it entirely, as small amounts of breast tissue may remain, and breast cancer can still develop in that tissue.
4. Impact on Sensation: After a mastectomy, sensation in the breast or nipple may be lost or reduced.
Alternatives to Prophylactic Mastectomy:
Some women at high risk for breast cancer choose to manage their risk without surgery by:
- Increased Surveillance: More frequent mammograms or MRIs to catch any signs of cancer early.
- Chemoprevention: Drugs like tamoxifen or raloxifene may reduce the risk of developing breast cancer in high-risk women.
Decision-Making:
Prophylactic mastectomy is a deeply personal choice. Women considering the surgery often work closely with a team of healthcare professionals, including oncologists, genetic counselors, and plastic surgeons, to weigh the benefits and risks based on their individual circumstances. At Hyderabad Breast Clinics our experts will help you understand the risk versus benefit in such complex decision making process and would also guide to expert genetic counsellors.