|  | Cancer | Breast Cancer

Guidelines for Bilateral Prophylactic Mastectomy

Bilateral prophylactic mastectomy is a surgical removal of both breasts designed to prevent or drastically reduce the potential occurrence of breast cancer. It is most typically used in cases where genetic examination or family history indicate a high risk of cancer development. The physical and emotional changes brought on by prophylactic mastectomy are significant, and clear treatment guidelines help determine an individual's suitability for the procedure.

  1. Determining Suitability for Treatment

    • The Society for Surgical Oncology cites several key factors in determining the appropriate use of bilateral prophylactic mastectomy. You may be suited for the procedure if testing reveals mutations in the genes known as BRCA 1 and BRCA 2. Abnormalities in these genes are direct indicators for increased cancer risk, and if you have them your chance of developing breast cancer by age 70 is roughly 40 percent to 85 percent. You may also be suited for treatment if you have two or more close family members---defined by the Mayo Clinic as your mother, grandmothers, sisters, daughters or aunts---who develop breast cancer before they are 50, or at any point before menopause. Additionally, you may be suited for prophylactic mastectomy if you have certain abnormalities in your breast tissue, including ductal or lobular hyperplasia (heightened rates of cell production or division). In some rare cases, your oncologist (cancer specialist) may consider the procedure in absence of these usual criteria.

    Talking With Your Doctors

    • Before undergoing prophylactic mastectomy, you will almost certainly benefit from combined discussions with several different medical specialists, including your oncologist, a pathologist (specialist in tissue diagnosis), a genetic counselor and a surgeon. During these discussions, you can gather more information about the procedure, as well as learn about less invasive treatment options. These options may include regular examinations to monitor any changes in your breast tissue, as well as preventive use of the medications tamoxifen and raloxifene. Your doctors will also talk to you about the risks and benefits of reconstructive breast surgery in the aftermath of mastectomy.

    Forms of Mastectomy

    • There are two main forms of bilateral prophylactic mastectomy. In a total mastectomy, your surgeon will remove your entire breast and nipple. In a subcutaneous mastectomy, your surgeon will remove your breast tissue, but leave your nipple in place. As a rule, total mastectomy provides superior cancer prevention when compared to subcutaneous mastectomy, and your surgeon will likely recommend this procedure.

    Breast Reconstruction

    • If you undergo breast reconstruction, it may be done either at the same time as your mastectomy, or at a later date. Planning for your reconstruction will begin before your mastectomy, and will involve an examination of your breasts. Potential reconstruction options include insertion of saline or silicone implants, as well as a technique called tissue flap reconstruction, which uses fat, skin and muscle collected from elsewhere on your body to rebuild your breast shape.

    Outcomes

    • Prophylactic mastectomy decreases your chances of developing breast cancer by roughly 90 percent. However, cancer can still develop from breast tissue cells in the chest wall, armpit or abdomen. Consult your doctors for a full explanation of recurrence risks.

Breast Cancer - Related Articles