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 [202,297-300].
However, it doesn't completely protect a woman from breast cancer [299-300]. 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.
Some women with inherited gene mutations that increase breast cancer risk may consider bilateral prophylactic mastectomy to lower their risk .
This includes women with a mutation in one of these genes :
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.
If you are 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 because younger women have more years of life ahead.
In addition to the emotional impact of losing both breasts, some women have body image issues that can affect how they feel sexually [330-333].
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.
Learn more about support groups.
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.
Learn more about breast reconstruction.
At this time, no federal laws require insurance providers 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 provider to learn about your plan’s coverage.
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 [301,303-308,587].
The National Comprehensive Cancer Network (NCCN) recommends women from families with hereditary ovarian cancer syndromes, including women who have a BRCA1 or BRCA2 mutation, have oophorectomy between ages 35-40 (or after childbearing is complete) .
Women with a BRCA2 mutation tend to be diagnosed with ovarian cancer at a later age than women with a BRCA1 mutation . So, women with a BRCA2 mutation who have had bilateral prophylactic mastectomy may delay oophorectomy until age 40-45 . However, if a family member was diagnosed with ovarian cancer at a young age, prophylactic oophorectomy may be recommended earlier .
Prophylactic oophorectomy may also lower the risk of breast cancer [309,587].
Some data suggest women with a BRCA1 gene mutation may have a slightly increased risk of uterine cancer . This topic is under study.
However, if you have a BRCA1 gene mutation and are having a prophylactic oophorectomy, it’s recommended you discuss with your health care provider the risks and benefits of having a hysterectomy (surgical removal of the uterus) at the time of the oophorectomy .
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 BRCA1/2 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 affected by hereditary breast and/or ovarian cancer.
Sharsheret has online support for Jewish women affected by hereditary breast and/or ovarian cancer.
SUSAN G. KOMEN® SUPPORT RESOURCES
* 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 at this time.
Facts for Life: Risk Lowering Options for Women at Higher Risk of Breast Cancer
Facts for Life: Breast Reconstruction & Prosthesis After Mastectomy