Preventive (prophylactic) mastectomy: Surgery to reduce breast cancer risk

Prophylactic mastectomy may reduce your risk of breast cancer. Learn how doctors assess breast cancer risk and how prophylactic mastectomy may help prevent breast cancer.

By Mayo Clinic Staff

Finding out you're at high risk of breast cancer leads to difficult questions and decisions.

One such question is whether to have preventive mastectomy (prophylactic mastectomy) — surgery to remove one or both breasts in hopes of preventing or reducing your risk of breast cancer.

Keep in mind that being identified as high risk doesn't mean you're certain to get breast cancer. All it means is that your likelihood of developing the disease is several times higher than that of an average-risk woman.

Understanding your individual level of risk can help you weigh your options for risk-reducing strategies, including prophylactic mastectomy.

Who may consider prophylactic mastectomy to reduce breast cancer risk?

All women are at risk of breast cancer just by being female and advancing in age. But some factors increase your risk significantly.

You may consider prophylactic mastectomy if you have:

  • Already had cancer in one breast. If you need to have one breast removed because of a new cancer diagnosis, and you have a very strong family history of breast cancer, you may decide to have the other, unaffected breast removed at the same time.
  • A family history of breast cancer. If your mother, sister or daughter has had breast cancer, especially if she was diagnosed before age 50, you may be at increased risk. If you have multiple family members — on your mother's or father's side — with breast or ovarian cancer, your risk of breast cancer may be greater.
  • Positive results from gene testing. Genetic testing can identify mutations in genes, such as BRCA1 and BRCA2, that substantially increase your risk of breast or other cancers. If you have a strong family history of breast cancer, consider meeting with a genetic counselor to discuss genetic testing. Women who are of Ashkenazi Jewish descent have a higher incidence of the BRCA1 and BRCA2 mutations.
  • Breast changes that significantly increase your risk of cancer. Your doctor may have discovered abnormal cells in the milk-producing glands of your breast, a condition known as lobular carcinoma in situ (LCIS). LCIS isn't cancer, but it's a marker of an increased risk of developing cancer in both breasts. If you have a strong family history of breast cancer and a personal history of LCIS, chemoprevention or prophylactic mastectomy may be options to manage your risk.
  • Radiation therapy. If you had radiation therapy to your chest between the ages of 10 and 30, you have an increased risk of developing breast cancer.
  • Dense breasts. Dense breast tissue is associated with breast cancer. Dense breast tissue also makes it harder for doctors to diagnose breast cancer. A woman with dense breasts may consider a prophylactic mastectomy, especially if she has other risk factors, such as a strong family history of breast cancer or precancerous conditions.

Your doctor determines whether you're at high risk of breast cancer based on your risk factors.

With whom should high-risk women discuss their options?

Deciding what to do with the knowledge that you are at high risk of breast cancer is a complex and time-consuming process. It's best if you can work with a team of health professionals to get a complete evaluation of your risk and take the time to understand all of your options.

Many breast centers are staffed with breast-health specialists, genetic counselors, breast surgeons and reconstructive surgeons who can collaborate with you. Second opinions are strongly recommended for women considering prophylactic mastectomy.

Making the decision whether to have prophylactic mastectomy is not urgent. Give yourself time to weigh all the pros and cons. You may want to discuss your concerns and feelings with a breast-health specialist and psychologist.

Nov. 27, 2014 See more In-depth