Prophylactic Double Mastectomy: FAQ

Preventive Double Mastectomy: FAQ

By Anna Nguyen
WebMD Feature

Preventive double mastectomy is surgery to remove both breasts as a way to try to prevent breast cancer.  

If you’re considering it, you need answers to the following questions.  

1. Why would someone without cancer consider having a preventive double mastectomy?

Some of the most common reasons  are:

  • Cancer in the family: Did your mother, sister, or daughter have breast cancer, especially before age 50? If more than one of them had breast or ovarian cancer, then you may be even more likely to get breast cancer.
  • BRCA1 or BRCA2 gene mutation: If you have a BRCA1 or BRCA2 mutation, you are five times more likely to ever get breast cancer than a woman without those mutations. It also makes ovarian cancer more likely. If you’re thinking about the test, see a genetics counselor to learn more.
  • You’ve had LCIS (lobular carcinoma in situ). LCIS isn’t cancer. It’s abnormal cells in the breast ducts. If you’ve had it, you may be more likely to get breast cancer.

There are other possible reasons, like if you’ve had breast cancer before and are trying to prevent it from coming back, or if you’ve had radiation therapy. In each of these cases, it’s a personal choice that each woman would make with her doctors.

2. How effective is the surgery?

Preventive mastectomy can cut the chance of getting breast cancer by up to 90% in women who are at moderate-to-high risk of getting breast cancer. 

But the procedure doesn’t completely prevent breast cancer.

Breast tissue isn’t just in the breasts. It’s also in the armpits, above the collarbone, and as far down as the abdomen, says Clifford A. Hudis, MD. He is chief of breast cancer medicine service at Memorial Sloan-Kettering Cancer Center. So removing the breasts doesn’t remove all that other breast tissue.

3. Are there other options?

Yes, but not with the same drop in breast cancer risk.

  • Prescription drugs: A woman at high risk for breast cancer could opt to take tamoxifen or another type of prescription drug called aromatase inhibitors. That would lower her risk by as much as 50%, says Todd Tuttle, MD, chief of surgical oncology at the University of Minnesota in Minneapolis.
  • Close observation by MRI, mammograms, and breast exams by a doctor, as well as noticing any changes in her breasts and telling her doctor about them. These don’t make breast cancer less likely, but may help find it sooner.

4. How long is the recovery time?

About a month, on average, Tuttle says.

5. Can I start breast reconstruction at the same time?

Yes. Many women do that. The surgeries take about 5-6 hours when done together, Tuttle says.

6. What are the side effects?

Like any surgery, there is risk. You may need more operations if you get an infection or if the tissue doesn’t heal, Tuttle says.

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