To avoid future cancer, some women at very high risk for breast cancer choose to have both breasts surgically removed, known as a bilateral prophylactic mastectomy or prophylactic mastectomy, which aims to remove all breast tissue that could form breast cancer.
Prophylactic breast cancer surgery may also be considered if a woman already has breast cancer and is at increased risk for cancer to reappear in either breast. Prophylactic mastectomy may also be considered if a woman has a BRCA1 or BRCA2 gene mutation (which can lead to an increased risk of breast cancer), a clear family history of breast cancer, or lobular atypical hyperplasia or lobular carcinoma in situ. Lobular atypical hyperplasia is an irregular arrangement of breast lobular cells, and lobular carcinoma in situ is non-invasive breast cancer.
Does prophylactic mastectomy prevent breast cancer?
Recent studies have shown that prophylactic mastectomy can reduce the risk of breast cancer by up to 100% if there is a clear family history of breast cancer or a BRCA gene mutation. However, the degree of risk reduction is related to many factors. In some studies, women underwent prophylactic mastectomy for non-high-risk reasons, such as pain, fibrocystic breast disease, dense breasts, cancer fear, or a family history of breast cancer.
Even if their breast tissue is removed, about 10% of women will still develop breast cancer. However, in most studies, women did not develop breast cancer after prophylactic mastectomy. However, many patients are not in the high-risk group for cancer.
Some experts believe that even in high-risk women, prophylactic mastectomy is not advisable because not all breast tissue is necessarily removed during the procedure. In addition, the only population that has a survival advantage (longer life expectancy) with prophylactic mastectomy is nonmenopausal women with hormone receptor-negative breast cancer. To determine the cause, we need to know the factors that damage breast tissue and the starting point of the cancer.
Where is the site of breast cancer formation?
Breast cancer may form within the glandular tissue of the breast, especially in the ducts and lobules of the breast. These ducts and lobules are located in all parts of the breast tissue, including the tissue beneath the skin. The breast tissue extends from the clavicle to the edge of the lower rib cage and from the middle of the chest to the sides and armpits.
In a mastectomy, tissue must be removed from below the skin to the chest wall and around the edges of the breast. However, based on the extent of the breast tissue and the location of these glands below the skin, it is not possible to remove every duct and lobule, even using a very thorough and delicate procedure.
Who should undergo prophylactic mastectomy?
Only women who are at very high risk for breast cancer should consider prophylactic mastectomy, as recommended by the American Association for Surgical Oncology. This includes women with one or more of the following risk factors:
- BRCA gene mutation
- Previous cancer in one breast and a clear family history of breast cancer
- History of lobular carcinoma in situ
Preventive mastectomy should be considered only after appropriate genetic and psychological counseling to discuss the psychosocial implications of surgery.
How is breast cancer surgery chosen?
For women who choose prophylactic mastectomy, a number of new and important surgical options are available.
Breast tissue can now be removed using a skin-preserving approach that removes only the breast tissue between the skin below and the chest wall. This approach removes most of the glands that may form breast cancer, and both the nipple and i.e., the areola are removed because the milk ducts converge toward the nipple, creating a dense area of ductal tissue. However, the skin of the breast is preserved, thereby preserving the appearance of the breast skin.
The combination of skin-preserving mastectomy with immediate breast reconstruction is very effective. Many women who choose prophylactic mastectomy, often in combination with immediate breast reconstruction, are very satisfied with their choice and the results of their reconstruction.
While surgery should not be recommended for all high-risk individuals, it is important for some women.
Patients must consult with their physician to learn about all suitable options.