Tina J. Hieken, M.D., Breast/Melanoma Surgery, Mayo Clinic: There are several approaches a woman can choose from to decrease your risk of future breast cancer.

Surgery to remove both breasts is one approach to breast cancer risk reduction. Generally, surgical risk reduction is most appropriate for women at the highest risk for breast cancer, those with a known dangerous genetic mutation or women with a very strong family history of breast cancer. Surgery to remove both breasts is estimated to reduce the risk of subsequent breast cancer by 90 to 95 percent. This means that for a woman whose estimated lifetime risk of breast cancer is 40%, the chance that she will be diagnosed with breast cancer in her lifetime after bilateral risk reducing mastectomies is reduced to around 2 to 4%.

There are three main types of bilateral risk reducing operations that can be performed. Total mastectomy is generally done without reconstruction. This operation involves removal of the nipple areolar complex and the skin overlying the breast, so that after complete removal of the underlying breast tissue, the incision can be closed in a smooth flat line. This attention to closure is important so that a woman can wear a prosthesis comfortably inside, a specially design bra or swimsuit if she desires.

A second type of risk reducing mastectomy, a skin-sparing mastectomy. In this operation, the nipple areolar complex is removed, but an envelope of the overlying breast skin is preserved while all of the underlying breast tissue is removed. This permits breast reconstruction to be initiated at the same operation.

The third type of risk reducing mastectomy as nipple-sparing mastectomy. In this operation, the skin of the breast including the nipple areolar complex is preserved, the underlying breast tissue is completely removed and breast reconstruction is initiated at the same operation. In suitable women, the incision for a nipple-sparing mastectomy can be placed as a hidden scar on the under surface or side of the breast. This creates the most natural appearing reconstructed breast.

At Mayo Clinic, our multi-disciplinary and high-volume practice includes highly skilled breast oncologic surgeons and reconstructive plastic surgeons. Our team has special expertise in these advanced procedures. We work together as a team with women who want breast reconstruction following mastectomy. Based on a woman's individual circumstances and her preferences, our team designs an optimal plan for surgical risk reduction. Our goal is to provide maximal cancer risk reduction with the very best possible aesthetic outcomes for each woman.