Risk-reducing bilateral mastectomy
Risk-reducing bilateral mastectomy (bilateral prophylactic mastectomy) is the removal of both breasts to prevent breast cancer.
Risk-reducing bilateral mastectomy lowers the risk of breast cancer in women at high risk by at least 90% [38,235-237]. However, it doesn’t completely protect a woman from breast cancer [235-237].
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.
Risk-reducing contralateral mastectomy
Risk-reducing contralateral mastectomy (contralateral prophylactic mastectomy) is the removal of the opposite (contralateral) breast in a person who has breast cancer in only one breast. It’s usually done at the same time as breast cancer surgery, so both breasts are removed during surgery.
The goal of risk-reducing contralateral mastectomy is to try and prevent breast cancer in the contralateral breast of women who have a very high risk of breast cancer. However, removing the contralateral breast does not lower the risk of dying from the original breast cancer .
The National Comprehensive Cancer Network (NCCN) recommends risk-reducing contralateral mastectomy only be considered for women who have a very high risk of breast cancer due an inherited gene mutation in one of these genes :
Learn more about mastectomy.
Who may want to consider risk-reducing bilateral mastectomy?
Women with certain inherited gene mutations have a greatly increased risk of breast cancer.
Women who have a very high risk of breast cancer due to a mutation in one of these genes may consider risk-reducing bilateral mastectomy to lower their risk of breast cancer :
Women may choose risk-reducing mastectomy to ease worries about getting breast cancer. It may also make them feel they’ve done all they can to lower their risk of breast cancer.
Pros and cons of risk-reducing bilateral mastectomy
If you’re at high risk for breast cancer, talk with your health care provider about the pros and cons of risk-reducing mastectomy. You may also want to discuss your breast reconstruction options with a plastic surgeon.
The benefits of risk-reducing mastectomy seem to be greater in younger women than in older women. This is because younger women have more years of life ahead.
- For a 30-year-old woman who has a BRCA1 or BRCA2 inherited gene mutation, risk-reducing mastectomy may add 3-5 years to her lifespan [238-239].
- For women 60 years and older, the gain in lifespan after risk-reducing bilateral mastectomy is small [38,237-239].
In addition to the emotional impact of losing both breasts, risk-reducing mastectomy affects how some women feel sexually [385-387]. Talking with a health care provider or counselor may help address these issues. It may also help to join a support group.
There are also surgical risks from risk-reducing mastectomy, including infection.
Learn more about sexuality and intimacy after breast surgery.
If you choose to have risk-reducing 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.
No federal laws require insurance companies to cover risk-reducing mastectomy.
Some state laws require coverage for risk-reducing mastectomy, but coverage varies state to state.
It’s best to check with your insurance company to learn about your plan’s coverage.
Learn more about health insurance.
Read our perspective on risk-reducing mastectomy.*
Some inherited gene mutations increase the risk of both breast and ovarian cancers. Risk-reducing bilateral salpingo-oophorectomy (prophylactic bilateral salpingo-oophorectomy) is the surgical removal of the fallopian tubes and the ovaries to prevent ovarian cancer. It can lower the risk of ovarian cancer by 70% to over 90% [38,238,240-244].
The National Comprehensive Cancer Network (NCCN) recommends women who have a family history of ovarian cancer likely due to an inherited gene mutation have (or consider having) risk-reducing bilateral salpingo-oophorectomy . This includes women who have an inherited mutation in one of these genes :
The age risk-reducing bilateral salpingo-oophorectomy is recommended varies by gene mutation .
Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 inherited gene mutation
The NCCN recommends women who have a BRCA1 or BRCA2 inherited gene mutation have risk-reducing bilateral salpingo-oophorectomy between ages 35-40 (or after childbearing is complete) to lower the risk of ovarian cancer .
Women with a BRCA2 gene mutation tend to be diagnosed with ovarian cancer at a later age than women with a BRCA1 gene mutation . So, women with a BRCA2 mutation may delay risk-reducing bilateral salpingo-oophorectomy until ages 40-45 .
However, if a family member was diagnosed with ovarian cancer at a young age, risk-reducing bilateral salpingo-oophorectomy for women with a BRCA2 gene mutation may be recommended earlier .
Risk-reducing salpingo-oophorectomy in women with other inherited gene mutations that increase breast and ovarian cancer risk
The NCCN recommends :
- Women who have a PALB2 inherited gene mutation consider having risk-reducing bilateral salpingo-oophorectomy after age 45
- Women who have a RAD51C or RAD51D inherited gene mutation consider having risk-reducing bilateral salpingo-oophorectomy between ages 45-50
Risk-reducing salpingo-oophorectomy and breast cancer risk
Risk-reducing bilateral salpingo-oophorectomy may also lower the risk of breast cancer in some women .
Risk-reducing salpingo-oophorectomy and hysterectomy
Some data suggest women with a BRCA1 inherited gene mutation may have a slightly increased risk of uterine cancer (serous type) . This topic is under study.
However, if you have a BRCA1 gene mutation and are having a risk-reducing bilateral salpingo-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 .
Risk-reducing salpingo-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.
Some support groups are tailored to people with BRCA1 or BRCA2 (BRCA1/2) inherited 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 provides online and telephone support and a resource guide for individuals and caregivers affected by hereditary breast, ovarian and other cancers.
Sharsheret offers online support for Jewish women affected by hereditary breast and/or ovarian cancer.
Susan G. Komen® Support Resources
Insurance issues and financial assistance
If you have insurance issues (such as a claim is denied) or need help paying for genetic testing, risk-lowering drugs or other out-of-pocket expenses, there are resources that may help.
Learn about insurance and financial assistance programs.
Komen Financial Assistance Program
Susan G. Komen® offers the Komen Financial Assistance Program to eligible individuals undergoing breast cancer treatment at any stage or living with metastatic breast cancer (stage 4).
Financial assistance is granted to those who meet pre-determined eligibility criteria.
To learn more about this program and other helpful resources, call the Komen Breast Care Helpline at 1-877 GO KOMEN (1-877-465-6636) or email email@example.com.
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* 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.