A preventive mastectomy or prophylactic mastectomy is an elective operation to remove the breasts so that the risk of

breast cancer Breast cancer is cancer that develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, milk rejection, fluid coming from the nipple, a newly inverted nipple, or a r ...

is reduced.

Indications

The procedure is a surgical option for individuals who are at high risk for the development of breast cancer. Women who had a bilateral mastectomy in 2013 were about 10 years younger than those who had a unilateral mastectomy. This preventive operation pertains to women with these characteristics: *

BRCA1 Breast cancer type 1 susceptibility protein is a protein that in humans is encoded by the ''BRCA1'' () gene. Orthologs are common in other vertebrate species, whereas invertebrate genomes may encode a more distantly related gene. ''BRCA1'' is a ...

BRCA2 ''BRCA2'' and BRCA2 () are a human gene and its protein product, respectively. The official symbol (BRCA2, italic for the gene, nonitalic for the protein) and the official name (originally breast cancer 2; currently BRCA2, DNA repair associated) ...

mutation carriers; this is the main indication for bilateral prophylactic mastectomy. * Cancer in one breast and a family history of breast cancer. * Family history of breast cancer. The genetic risk can be passed down through the mother’s or father’s side. *

Radiation therapy Radiation therapy or radiotherapy, often abbreviated RT, RTx, or XRT, is a therapy using ionizing radiation, generally provided as part of cancer treatment to control or kill malignant cells and normally delivered by a linear accelerator. Radi ...

to the chest before the age of 30. * Presence of

lobular carcinoma in situ Lobular carcinoma ''in situ'' (LCIS) is an incidental microscopic finding with characteristic cellular morphology and multifocal tissue patterns. The condition is a laboratory diagnosis and refers to unusual cells in the lobules of the breast. Th ...

. * Having dense breasts or breasts with diffuse microcalcification, as the screening for breast cancer is made difficult. Discussions and decision should be made with the help of specialists who can use relevant information and statistical models to predict the individual lifetime risk of development of breast cancer. Undergoing a preventive mastectomy does not guarantee that breast cancer will not develop later, however, it reduces the risk by 90% in high risk women. Also, a preventive mastectomy may not be able to remove all breast tissue as some of it may be in the arm pit, near the collar bone, or in the abdominal wall. Male carriers of BRCA1 and BRCA2 mutations have a higher risk of breast cancer than other males, approximately 1.2% and 6.8%, but their risk is much lower than in female mutation carriers (about 60%) and lower than in the general female population (12%). Thus, preventive mastectomy has not been advocated for affected men.

Procedure

In most situations the operation involves both breasts and thus represents a bilateral procedure. When cancer has affected already one breast, the other breast, still healthy, may be removed in a unilateral preventive mastectomy. Typically either a simple, a subcutaneous or a nipple-sparing mastectomy is performed. With the former the areola and

nipple The nipple is a raised region of tissue on the surface of the breast from which, in females, milk leaves the breast through the lactiferous ducts to feed an infant. The milk can flow through the nipple passively or it can be ejected by smooth ...

are removed, while the other two approaches preserve the nipple area for cosmetic reasons. To increase the

viability Viability is the ability of a thing (a living organism, an artificial system, an idea, etc.) to maintain itself or recover its potentialities. Viability or viable may refer to: Biology, medicine or ecology * Viability selection, the selection of ...

of the nipple area for preservation during mastectomy, a so-called "nipple delay" procedure can be done several weeks before the mastectomy. Reconstructive breast surgery can be performed in the same surgical setting, added after the mastectomy. Saline or silicone implants may be used in the reshaping process and may be placed in a later setting. A preventive mastectomy carries certain risks including those of anesthesia, bleeding, infection, pain, disfiguration, anxiety and disappointment. After surgery, routine screening for breast cancer is recommended.

Alternatives

There are other options to reduce the risk of future breast cancer. Intensified breast cancer screening for high risk women may detect cancer at an early, treatable stage. Certain medications that block the effect of

estrogen Estrogen or oestrogen is a category of sex hormone responsible for the development and regulation of the female reproductive system and secondary sex characteristics. There are three major endogenous estrogens that have estrogenic hormonal activ ...

(i.e.

tamoxifen Tamoxifen, sold under the brand name Nolvadex among others, is a selective estrogen receptor modulator used to prevent breast cancer in women and treat breast cancer in women and men. It is also being studied for other types of cancer. It has ...

, raloxifen,

exemestane Exemestane, sold under the brand name Aromasin among others, is a medication used to treat breast cancer. It is a member of the class of antiestrogens known as aromatase inhibitors. Some breast cancers require estrogen to grow. Those cancers hav ...

) can reduce the risk by about 50% but also have side effects. Prophylactic salpingo-

oophorectomy Oophorectomy (; from Greek , , 'egg-bearing' and , , 'a cutting out of'), historically also called ''ovariotomy'' is the surgical removal of an ovary or ovaries. The surgery is also called ovariectomy, but this term is mostly used in reference to ...

reduces estrogen levels and the risk of both ovarian and breast cancer, however, the reduction in breast cancer risk is about 50% in high risk women as compared to 90% when preventive mastectomy is done.

Lifestyle Lifestyle often refers to: * Lifestyle (sociology), the way a person lives * ''Otium'', ancient Roman concept of a lifestyle * Style of life (german: Lebensstil, link=no), dealing with the dynamics of personality Lifestyle may also refer to: Bus ...

changes (in weight, diet, exercise, avoidance of smoking, limiting alcohol) may reduce the risk to some degree.

Acceptance

A factor that facilitates the decision to undergo a preventive mastectomy is that results of breast reconstructive surgery have improved. A 2004 Canadian study found that 70% of women were satisfied or extremely satisfied with the reconstruction after bilateral prophylactic mastectomy. In the United States preventive mastectomy is gaining increased acceptance. The decision of famous actresses such as

Christina Applegate Christina Applegate (born November 25, 1971) is an American actress. As a child actress, she gained recognition for starring as Kelly Bundy in the Fox sitcom '' Married... with Children'' (1987–1997). Applegate established a successful film a ...

and

Angelina Jolie Angelina Jolie (; born Angelina Jolie Voight; June 4, 1975) is an American actress, filmmaker, humanitarian and former Special Envoy to the UN High Commissioner for Refugees. The recipient of numerous accolades, including an Academy Award ...

to undergo preventive mastectomy has given the procedure wider media attention. The trend towards prophylactic mastectomy appears to be less pronounced in Europe and India.

References

{{reflist Breast cancer Breast surgery Obstetrical and gynaecological procedures Surgical oncology Surgical removal procedures