The Who, What, Where, When and Sometimes, Why.

Preventive Surgery

Prophylactic mastectomy

Bilateral prophylactic mastectomy

Bilateral prophylactic mastectomy is the removal of both breasts to prevent breast cancer.

Bilateral prophylactic mastectomy lowers the risk of breast cancer in women at high risk by at least 90 percent [147,224-227].

However, it doesn’t completely protect a woman from breast cancer [226-227]. A mastectomy isn’t able to remove all of a woman’s breast tissue. This means there’s always a small chance breast cancer could occur in the remaining tissue.

Contralateral prophylactic mastectomy

Contralateral prophylactic mastectomy is the removal of the opposite (contralateral) healthy breast in a woman diagnosed with breast cancer in one breast. It’s usually done at the same time as breast cancer surgery.

Learn more about contralateral prophylactic mastectomy.

Who may want to consider bilateral prophylactic mastectomy?

Some women have an inherited gene mutation that greatly increases breast cancer risk.

Women with a high-risk mutation in one of these genes may consider bilateral prophylactic mastectomy to lower their risk [147]:

  • BRCA1
  • BRCA2
  • PALB2
  • PTEN
  • TP53

Women may choose prophylactic mastectomy to ease worries about getting breast cancer. It may also make them feel they have done all they can do to lower their risk of breast cancer.

Pros and cons of bilateral prophylactic mastectomy

If you’re at high risk for breast cancer, talk with your health care provider about the pros and cons of prophylactic mastectomy. You may also want to discuss your options for breast reconstruction with a plastic surgeon.

The benefits of prophylactic mastectomy seem to be greater in younger women than older women. This is because younger women have more years of life ahead.

  • For a 30-year old woman who has a BRCA1 orBRCA2 gene mutation, prophylactic mastectomy may add 3-5 years to her lifespan [147,224-227].
  • For women 60 years and older, the gain in lifespan after a prophylactic mastectomy is small [147,224-227].

In addition to the emotional impact of losing both breasts, some women have body image issues that can affect how they feel sexually after prophylactic mastectomy [344-346].

There are also risks from the surgery, including infection.

Talking with a health care provider or counselor, or joining a support group, can help address these issues.

Learn more about sexuality and intimacy after breast surgery.

Breast reconstruction

If you choose to have a prophylactic mastectomy, you may wish to have breast reconstruction. This may be done at the same time as the mastectomy or at a later time.

Talk with a plastic surgeon about your reconstruction options.

Insurance coverage

No federal laws require insurance companies to cover prophylactic mastectomy.

Some state laws require coverage for prophylactic mastectomy, but coverage varies state to state.

It’s best to check with your insurance company to learn about your plan’s coverage. 

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Komen Perspectives

Read our perspective on prophylactic mastectomy.*

 

Prophylactic oophorectomy

Some inherited gene mutations increase the risk of both breast and ovarian cancers. Prophylactic oophorectomy is the surgical removal of the ovaries to prevent ovarian cancer. It can lower the risk of ovarian cancer by 70 to over 90 percent [147,228,230-235,587].

The National Comprehensive Cancer Network (NCCN) recommends women from families with hereditary ovarian cancer syndromes have (or consider having) prophylactic oophorectomy [147]. This includes women who have a BRCA1, BRCA2, BRIP1, RAD51C or RAD51D gene mutation [147]. The age oophorectomy is recommended varies by gene mutation [147].

Prophylactic oophorectomy in women with a BRCA1 or BRCA2 mutation

The NCCN recommends women who have a BRCA1 or BRCA2 mutation have prophylactic oophorectomy between ages 35-40 (or after childbearing is complete) [147].

Women with a BRCA2 mutation tend to be diagnosed with ovarian cancer at a later age than women with a BRCA1 mutation [147]. So, women with a BRCA2 mutation who have had bilateral prophylactic mastectomy may delay oophorectomy until age 40-45 [147].

However, if a family member was diagnosed with ovarian cancer at a young age, prophylactic oophorectomy for women with a BRCA2 mutation may be recommended earlier [147].

Prophylactic oophorectomy in women with other gene mutations that increase breast cancer risk

NCCN recommends women who have a BRIP1, RAD51C or RAD51D gene mutation consider having prophylactic oophorectomy between ages between 45-50 [147].

Prophylactic oophorectomy and breast cancer risk

Prophylactic oophorectomy may also lower the risk of breast cancer [147,236].

Prophylactic oophorectomy and hysterectomy

Some data suggest women with a BRCA1 gene mutation may have a slightly increased risk of uterine cancer [147]. This topic is under study.

However, if you have a BRCA1 gene mutation and are having a prophylactic oophorectomy, talk with your health care provider about the risks and benefits of having a hysterectomy (surgical removal of the uterus) at the same time [147].

Prophylactic oophorectomy and menopause

By removing the ovaries, oophorectomy stops the production of estrogen and progesterone. If you are premenopausal, this will permanently end your menstrual periods and lead to early menopause.

Learn more about early menopause and how to manage its symptoms.

Support

Some support groups are tailored to people with BRCA1/2 gene mutations and those with BRCA1/2-related breast cancers.

Our Support section offers a list of resources to help you find local and online support groups. For example, FORCE offers online support for women at higher risk of breast, ovarian or other cancers related to family history or inherited gene mutations.

Sharsheret offers online support for Jewish women affected by hereditary breast and/or ovarian cancer.

 SUSAN G. KOMEN® SUPPORT RESOURCES 

  • If you or a loved one needs more information about breast health or breast cancer, call the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877-465-6636). All calls are answered by a trained specialist or oncology social worker in English and Spanish, Monday through Friday from 9:00 a.m. to 10:00 p.m. ET. You can also email the helpline at helpline@komen.org.  
  • We offer an online support community through our closed Facebook Group – Komen Breast Cancer group. The Facebook group provides a place where those with a connection to breast cancer can discuss each other’s experiences and build strong relationships to provide support to each other. Visit Facebook and search for “Komen Breast Cancer group” to request to join the closed group.
  • Komen Affiliates offer breast health education as well as fund breast cancer programs through local community organizations. Your local Affiliate may also help you find breast cancer resources in your area. Find your local Affiliate.
  • Our fact sheets, booklets and other education materials offer additional information.

 

* Please note, the information provided within Komen Perspectives articles is current as of the date of posting. Therefore, some information may be out of date.