Bilateral prophylactic (PRO-fih-LAK-tik) mastectomy is the removal of both breasts to prevent breast cancer. Studies suggest prophylactic bilateral mastectomy can lower the risk of breast cancer in women at high risk by at least 90 percent [246,248-252].
Some BRCA1 or BRCA2 carriers and women with a strong family history may choose this option to ease worries about getting breast cancer. It may make them feel they have done all they can do to lower their risk of breast cancer.
A woman at high risk for breast cancer should talk with her health care provider about the pros and cons of prophylactic mastectomy. Prophylactic mastectomy does not completely protect a woman from breast cancer [251-252]. A mastectomy is not able to remove all of a woman's breast tissue. This means there is always a small chance breast cancer could occur in the remaining tissue.
The benefits of prophylactic mastectomy seem to be greatest in younger women. Younger women have more years of life ahead than older women. For a 30-year old woman who has a BRCA1 or BRCA2 gene mutation, the procedure may add three to five years to her lifespan [249,253-254]. For women 60 years and older, the gain in lifespan after a prophylactic mastectomy is small.
Prophylactic mastectomy has some risks, including problems (such as infection) from surgery. And, in addition to the emotional impact of losing both breasts, some women have body image issues that can affect how they feel sexually [251,285-287]. 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.
Learn more about support groups.
If you choose to have a prophylactic mastectomy, you may wish to have breast reconstruction at the same time as the mastectomy or at a later time.
Learn more about breast reconstruction.
At this time, no federal laws require insurance providers to cover prophylactic mastectomy. Some states do have a law requiring coverage for prophylactic mastectomy, but coverage varies state to state.
It is best to check with your insurance provider to learn about your plan’s coverage.
Read our perspective on prophylactic mastectomy (February 2014).*
Women with a BRCA1 or BRCA2 gene mutation are at higher risk of both breast cancer and ovarian cancer. One option for reducing these risks is prophylactic oophorectomy (surgical removal of the ovaries). This procedure [246,253,255-260]:
The National Comprehensive Cancer Network (NCCN) recommends women from families with hereditary ovarian cancer syndromes, including BRCA1/2 carriers, have oophorectomy between ages 35 and 40 (or after childbearing is complete) .
Some support groups are tailored for BRCA1/2 carriers and those with BRCA-related cancers. Our Support section offers a list of resources to help find a local or online support group. For example, FORCE and Sharsheret are organizations that have on-line support for women affected by hereditary breast and/or ovarian cancer.
Komen Support Resources
Facts for Life: Prophylactic Mastectomy
Facts for Life: Breast Reconstruction & Prosthesis