Living with cancer blog

Preventive mastectomy — a personal choice

By Sheryl M. Ness, R.N. May 25, 2013

Are you someone who's struggled with the decision to have preventive mastectomy?

The news that Angelina Jolie underwent a preventive double mastectomy after discovering that she carried a BRCA gene mutation is a situation other women sometimes face — or already have faced.

It's not an easy decision, and it's not always clear, but it's an option — and a personal choice.

BRCA1 and BRCA2 gene mutations are uncommon. However, if you've inherited the BRCA gene mutation, you have a much higher risk for developing breast and ovarian cancer.

Making the decision to remove both breasts can reduce your risk of developing breast cancer by 90 percent. However, it doesn't guarantee you'll never develop breast cancer because it's difficult to remove all of your breast tissue.

Every woman faced with this decision needs to weigh the benefits and risks and decide what's best for her. The emotional burden can be significant in deciding when to have the procedure based on life circumstances and if one is still of child bearing age.

A preventive mastectomy is really a personalized decision. Here are a few important points to consider when making your decision:

  • Take your time — this is not an urgent decision. Consider all the information you have and ask all of the questions you need to ask. Discuss your concerns with a breast specialist who is willing to guide you through the decision-making process.
  • Talk with other women who've been through the surgery. Everyone has a unique experience — talking with others who've been through the same surgery can give you a sense of what to expect.
  • Meet with the breast surgeon and plastic surgeon — discuss your options for reconstruction. Mastectomy with reconstruction is an extensive process and can take many months to complete. Ask about the risks and complications. Get a sense of how much time is needed to complete each step and recover.
  • Consider talking with a counselor — talk about how to anticipate and positively deal with the changes in your appearance, body image and life circumstances.
  • Talk with your family — be open and honest about the emotions and fears that you and your family may experience during and after the surgery.

If you're at high risk and decide that preventive mastectomy isn't the best choice for you, keep in mind that you have other strategies for early detection and risk reduction, which include:

  • Breast cancer screening and surveillance — based on your personal risk, which may involve mammogram and breast MRI screening every year beginning as early as age 30.
  • Clinical breast exam performed by your health care provider on a regular basis — as well as breast self-exams on your own to be aware of any changes in your breasts.
  • Talk with your health care provider — about the risks and benefits of using preventive drugs that block the effects of estrogen (chemoprevention).
  • Surgery to remove the ovaries — BRCA mutation also carries an increased risk of ovarian cancer. Removing the ovaries also reduces the risk of breast cancer in women who are at high risk.
  • Healthy lifestyle changes — including maintaining a healthy weight, daily exercise and limiting alcohol use.
  • Avoid the use of estrogen hormone therapy during and after menopause.

For more information on this topic, see our previous blog entry "BRCA testing can help you understand your risk."

On MayoClinic.com, see " BRCA gene test for breast cancer" and "Prophylactic mastectomy: Surgery to reduce breast cancer risk."

I'd love to have you share your experiences with each other on the blog. Peer support is powerful and makes such a difference.

Follow me on Twitter @SherylNess1. Join the discussion at #livingwithcancer.

With

Sheryl M. Ness, R.N.

Follow on Twitter: @SherylNess1

May 25, 2013