A prophylactic mastectomy is a preventive surgery that helps reduce a person’s risk of breast cancer by up to 95%. During the procedure, a surgeon will remove most breast tissue from one or both breasts.
A prophylactic mastectomy is surgery to help prevent breast cancer. Breast cancer remains the
Also known as a preventive mastectomy or risk-reducing mastectomy, a prophylactic mastectomy aims to help women with a high risk of breast cancer significantly reduce their risk — and it’s successful for many.
During this procedure, a surgeon will remove most breast tissue from one or both breasts. In some cases, other tissues, including the nipple or areola, are removed, too.
Because it’s not possible to remove all breast tissue, some people may still later develop cancer. But in women with a high risk of breast cancer, prophylactic mastectomy can significantly lower that risk.
It’s important to know this preventive surgery can help lower a person’s risk of breast cancer, but it may not prevent it entirely. It’s nearly impossible to remove all breast tissue during surgery, so many people will need to continue having scans and checks to ensure cancer doesn’t develop.
This article uses the terms “women,” “mother,” “sister,” and “daughter” to refer to people assigned female at birth to align with the terms used in the research cited.
Although your gender identity may influence the factors to consider when deciding whether a prophylactic mastectomy is right for you, your gender identity may not align with your breast cancer risk.
It’s important to note that prophylactic mastectomy is also an option for people assigned male at birth, although their risk of breast cancer is
However, a prophylactic mastectomy doesn’t guarantee a person will never develop breast cancer. It’s nearly impossible to remove all breast tissue during the surgery, and where breast tissue remains, cancer can develop.
Two types of mastectomies are used for breast cancer prevention. These include:
- Bilateral prophylactic mastectomy: This involves removing both breasts before cancer is diagnosed.
- Contralateral prophylactic mastectomy: This involves removing the opposite breast after breast cancer is diagnosed in one breast.
Once the choice is made to remove both breasts or one breast only, a few types of surgery can be used:
- Simple or total mastectomy: This type includes removal of all of the nipple, areola, and all breast tissue.
- Skin-sparing mastectomy: The skin of the nipple, the areola, and all of the breast tissue under the skin are removed, but most of the breast skin is preserved; this is usually followed by implants or breast reconstruction.
- Nipple-sparing mastectomy: All breast tissue is removed but the nipple remains intact; this is also often followed by reconstruction.
People with certain risk factors are the best candidates for a prophylactic mastectomy. These factors include:
- Genetic mutation: Women with certain gene mutations, such as BRCA1 and BRCA2 mutations, are at higher risk of developing breast cancer. These gene mutations are usually detected during genetic testing. Not everyone with these mutations will develop cancer, but reducing the risk of cancer may be important to people with genetic susceptibility.
- A strong family history of breast cancer: People who have a sister, mother, or daughter who has had breast cancer diagnosed, especially if breast cancer was diagnosed before age 50, may have a greater risk than people without a family connection.
- A personal or family history of ovarian cancer: If you or a close family member has had ovarian cancer, your risk of developing breast cancer may be higher. Genetic testing will help determine your risks.
- A history of radiation therapy: People who’ve had radiation therapy to their chest before age 30 have a
higher riskof developing breast cancer.
- An LCIS diagnosis: Lobular carcinoma in situ (LCIS) is a benign condition that
can increase your riskof developing breast cancer later.
Meredith Bradford, a public relations executive in Denver, chose to have a prophylactic mastectomy when a mammogram revealed microcalcifications in her right breast in 2017.
“I was good about getting my mammogram. It wasn’t like I had [skipped] 4 years. I was going every year,” Bradford said. Her doctor told her that 90% of these calcifications are benign, but he sent her for a biopsy anyway. “With a 90% rate, I thought I’m fine. My mom doesn’t have breast cancer, so I wasn’t thinking I’m super high risk.”
A few days later, on her way to work, a nurse called with a diagnosis: not cancer, but atypical lobular hyperplasia, a type of benign breast condition that causes cells near the milk duct to multiply, which can turn into cancer.
“I had never even heard of that,” Bradford says. “They referred me to a breast surgeon, but I didn’t feel a huge sense of urgency because they told me it’s not cancer. I knew this was preventative.”
Bradford continues, “I had a
Ultimately, Bradford says the choice came down to her intuition and her busy schedule: “In my gut, it was the right thing to do. There are a lot of risks with surgery, but for me, it felt like the right thing to do. I didn’t want to have scan-xiety, and [having scans] every 6 months would be hard because I travel for work.”
A surgeon or surgery care team will prepare you with instructions before your procedure, so make sure you write down any questions you have for them so you can get answers prior to surgery day.
On the day of surgery, you’ll arrive at the hospital or surgery center and be taken to a preparation room. There, you’ll change into a hospital gown and have an intravenous (IV) line placed in your arm or hand. The IV line will deliver medications, including anesthetic, during the surgery.
The exact steps of a prophylactic mastectomy vary based on the type of mastectomy you choose to have, but they largely follow this outline:
- Your skin is cleaned and prepared for surgery.
- The surgeon makes an incision in the breast. They’ll separate the breast tissue from the skin and chest muscles.
- They’ll remove the breast tissue and any other skin that’s necessary to remove, including the nipple and areola.
- If you elected to have breast reconstruction, that will happen once the breast tissue is removed.
- Long tubes, also known as drains, will be placed in your chest. This helps the body drain any excess fluid during recovery. These will be removed later.
- The surgeon will close the incisions and cover them with bandages to prevent infection.
A prophylactic mastectomy usually takes several hours, but it will be longer if you decide to have breast reconstruction done at the same time.
Recovery from a prophylactic mastectomy can take some time, and you may not be able to resume your typical activities for several months.
Immediately after the surgery, you may stay in the hospital for at least 1 night. After that, you can be released to go home, but you’ll continue to have regular check-ins with the surgeons and cancer care team to make sure you’re healing well.
You may also work with a physical therapist to learn exercises to help you remain flexible and decrease stiffness in your arms and shoulders.
“Recovery is hard. You have these drains in, so I remember standing over my kitchen sink with my mom and my husband washing my hair,” Bradford says. “I got a reclining chair medical rental because you can’t get yourself out of bed.”
She adds, “After 6 weeks, I was doing OK, but the first 2 weeks are rough.”
The most common risks associated with this surgery include:
- fluid collecting under the skin (seroma)
- reaction to anesthetic
- nerve damage or loss of sensation in the breasts and nipples
- delayed wound healing
- scar tissue pain
If you choose to have breast reconstruction, you may have other risks, including irregular breast appearance, muscle tightness, infection, and poor wound healing.
The emotional impact
A prophylactic mastectomy may be a physical surgery, but the emotional and mental impact can be very significant.
Many people experience anxiety and depression following the surgery. Reduced sensation, especially in the nipples, may impact arousal and sexuality.
Changes in your appearance can cause self-esteem and body image issues. Following the surgery, consider working with a therapist or seeking out a support group to help you navigate these feelings and your reactions to them.
These organizations may help you find support:
Yes, preventive breast cancer surgery isn’t the only way to reduce your cancer risk. Other options include:
- Medications: Certain estrogen-blocking drugs may help lower your risk of developing breast cancer.
- Screening: Instead of removing your breasts, you can choose to increase screenings. This may include additional mammograms or breast MRIs to watch for and hopefully detect changes earlier.
- Lifestyle adjustments: Certain healthy lifestyle factors can help reduce the risk of cancer. These include maintaining a moderate weight, staying physically active, and avoiding or greatly reducing how much alcohol you drink.
A prophylactic mastectomy isn’t a good option for every person. In fact, people at average risk of breast cancer may see no benefit from this surgery. If you think you may be a candidate, consider asking doctors these questions to understand if this is the right choice for you:
- Do I have a greater than average risk of developing breast cancer?
- Why? Is it from a genetic mutation, family history, or other factors?
- If I don’t want to have surgery, what do my options for breast cancer prevention look like?
- How long do I have to decide?
- Will I need additional surgery, including removing my ovaries?
Also, don’t be afraid to get a second opinion. Doctors bring a wide array of knowledge and experience to their discussions with you, but each person is different. Hearing from these varying perspectives may help you sort through what’s right for you and your future.
Bradford ultimately also had her ovaries removed. Genetic testing revealed she has the BRIP1 gene mutation, which increases the risk of developing breast and ovarian cancers.
“My oncologist said, “Look, you have BRIP1. That puts you at a higher risk of ovarian cancer, so get them out in the next year.’ So I did.”
These questions are commonly asked by people considering a prophylactic mastectomy:
Is prophylactic mastectomy covered by insurance?
Insurance companies aren’t required to cover prophylactic mastectomies. They also don’t have to cover the genetic testing that may help you understand your risks. However, many do.
If you have insurance, check with your insurance provider before you begin these tests to understand what your coverage is and what, if any, payment responsibility you have.
Is the procedure painful?
A prophylactic mastectomy is major surgery, and it can be painful, especially in the arms and chest. However, most people can manage this pain with over-the-counter medication, and they won’t need it for more than a few weeks.
Do I have to decide right away?
In most cases, no, you don’t need to decide right away. “Prophylactic” means this surgery is designed to prevent cancer, not treat existing cancer. This should give you some time to decide.
What is removed in a prophylactic mastectomy?
This depends on the type of mastectomy you have, but in most cases, all of the breast tissue is removed from one or both breasts. The breast nipple and areola may also be removed. Be sure to discuss the specific details regarding your prophylactic mastectomy with a breast surgeon beforehand.
If you have an increased risk of developing breast cancer, you may be considering preventive measures, such as a prophylactic mastectomy. This surgery removes all the breast tissue in one or both breasts, and for people at a high risk of developing breast cancer, it can reduce that risk by up to
However, this surgery isn’t right for everyone, and it may not benefit everyone either. Talk with a doctor, a genetic counselor, or a breast health specialist to understand your risk of breast cancer and the potential benefit you might have from this surgery.