Breast Cancer: Mastectomy to Lower Risk

Surgery to Lower Breast Cancer Risk

This section covers the following topics:

Risk-reducing mastectomy	Surgical risks
Who should consider surgery?	Recovery from surgery
Types of mastectomy

Note that when we use the terms "male" and "men" we are referring to people assigned male at birth. When we use the terms "female" and "women" we are referring to people assigned female at birth. 

Risk-reducing mastectomy

Mastectomy is surgery to remove one or both breasts to treat or prevent breast cancer.  “Prophylactic mastectomy” or "risk-reducing mastectomy" refers to the removal of healthy breasts to reduce a person's risk of developing breast cancer. For women with a high risk for breast cancer due to an inherited mutation, bilateral mastectomy is the most effective way to lower the risk for cancer.

Mastectomy does not completely eliminate the risk for breast cancer. Small amounts of breast tissue may remain even after surgery.

It's important for people to speak with a genetics expert in order to learn as much as possible about their breast cancer risk and to make an informed decision about the best option for lowering their risk. 

Who should have risk-reducing surgery?

The National Comprehensive Cancer Network (NCCN), is an organization of cancer experts that creates guidelines on cancer care and updates them yearly. The guidelines recommend that people with the mutations in the genes below discuss the benefits, risk, limitations and costs of risk-reducing mastectomy with their doctor.

BRCA1	PTEN
BRCA2	STK11
CDH1	TP53
PALB2

 

For women with mutations in other genes, the NCCN recommends basing the decision of mastectomy on personal and family history of cancer. 

NCCN recommends increased screening for high-risk women who choose not to have risk-reducing mastectomy. 

The guidelines do not recommend risk-reducing mastectomy to lower the risk for male breast cancer. For men diagnosed with breast cancer, treatment usually involves mastectomy on the affected side. Although some men who have been diagnosed with breast cancer in one breast choose to remove both breasts, there is very little research to show that the benefits of removing the other breast outweigh the risks. 

Types of mastectomies

A generation ago, mastectomy meant one thing: removal of the breast and chest muscle. Today, different types of mastectomy are available, including: 

• Modified radical mastectomy
  A modified radical mastectomy removes the entire breast and includes “axillary dissection” (removal of the lymph nodes from the armpit).
• Simple mastectomy
  A simple mastectomy removes the entire breast but does not include axillary dissection. However, a limited number of axillary lymph nodes, known as sentinel nodes, may be removed with a simple mastectomy
• Skin-sparing mastectomy
  For skin-sparing mastectomy, the breast tissue is removed, but most of the breast skin is saved to hold and shape the reconstructed breast. Most commonly, the nipple and areola are removed, but the areola may be preserved. In a skin-sparing mastectomy, incisions may be made within or around the areola, in the inframammary fold (bra line) or on the side of the breast.  Research shows skin-sparing mastectomies do not increase the risk for breast cancer recurrence in patients with early stage breast cancer. Skin-sparing mastectomies are commonly used for risk-reducing mastectomy when immediate reconstruction is planned. Skin-sparing may be used with both modified radical and simple mastectomies.  
• Nipple-sparing mastectomy
  Nipple-sparing mastectomy is a type of skin-sparing surgery that leaves the areola and nipple intact. There are several different options for incision placement, and this may depend on the patient’s breast size, type of reconstruction planned, and desired size after surgery. Nipple-sparing may be used with both modified radical and simple mastectomies.  

In people already diagnosed with breast cancer, the location and size of the cancer may affect the type of mastectomy they can have. Most of the time, reconstruction can be done at the same time as mastectomy. See our section on Breast Reconstruction for more information.  It is important to have a discussion with your surgeon about the benefits, risks and limitations of each option. 

Surgical risks

Every surgery has potential risks; some are more serious than others. Some mastectomy risks can affect recovery. Others can affect the type of scarring and appearance of the breast reconstruction. Some possible risks include:

• Infection
• Fluid build-up at the surgical site (seroma or hematoma)
• Delayed healing
• Blood loss
• Blood clots
• Lack of breast or chest feeling or sensation
• Pain (post-operative and long term pain syndromes)

It is important for people to discuss possible surgical risks with a surgeon to understand the seriousness and likelihood of these risks before making the decision to have risk-reducing surgery.

Recovery

Recovery times after mastectomy vary depending on several factors including whether or not there will be reconstruction and the type of reconstruction chosen. Average recovery time after mastectomy and reconstruction is about 3-4 weeks, but may be up to 6-8 weeks. 

Physical therapy may help to restore range of motion, decrease discomfort and reduce buildup of scar tissue.