Prophylactic mastectomy

A prophylactic mastectomy (also called a preventive or risk-reduction mastectomy) involves removing one or both breasts to reduce the risk of developing the disease. This procedure is generally reserved for women who are at very high risk of developing breast cancer.

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Prophylactic mastectomy and any subsequent breast reconstruction are major surgical procedures. Although mastectomy significantly reduces the risk of breast cancer in high-risk women, it does not offer a guarantee because it cannot remove all breast tissue, which is widely distributed across the chest wall. Before seriously considering whether to undergo this surgery women need a clear understanding of their own risk and should consider discussing their options with a genetic counselor. Physicians also will help patients assess their risk and discuss the pros and cons of the procedure.

Being identified as high risk does not mean a patient will definitely get cancer, but under certain conditions prophylactic mastectomy may be an appropriate procedure:

Family or personal history: A woman might be a candidate for prophylactic mastectomy if she has had two or more first-degree relatives--mother, sister, or daughter--with the disease, particularly if the relatives were diagnosed before age 50 or had bilateral breast cancer. So might a woman who has already had cancer in one breast. Women who have had cancer in one breast are at a higher risk of developing cancer in the other breast.

Genetic factors: Genetic testing can identify people who have an abnormal breast cancer gene (BRCA1 or BRCA2) associated with an inherited type of breast cancer. Genetic testing also makes sense for individuals with a strong family history of breast cancer (involving multiple women on either side of the family) or other cancers (such as ovarian, colon, or prostate cancer) as well as individuals with a male family member diagnosed with breast cancer.

LCIS (lobular carcinoma in situ): Women with LCIS are five times as likely to develop breast cancer as women who do not have this precancerous condition. A woman with LCIS and a family history of breast cancer is at even higher risk.