When Is Bilateral Mastectomy Necessary?

woman getting comfort at home

A bilateral mastectomy is the surgical removal of both breasts to treat or prevent breast cancer. In some cases, it is a necessary procedure—such as when an advanced cancer is found in both breasts simultaneously. In other cases, a woman may choose to have both breasts removed at the same time even though it is not considered medically necessary.

Reasons for Choosing a Bilateral Mastectomy

Cancer that is advanced enough to warrant a bilateral, or double, mastectomy is very rarely found in both breasts simultaneously.

More commonly, women opt for a bilateral mastectomy for other reasons. When both breasts are removed in these cases, it is known as a contralateral prophylactic mastectomy (CPM). Reasons for a CPM include:

Fear of recurrence in the other breast

A 2017 study found that the rate of women who opted for a CPM after being diagnosed with invasive cancer in one breast tripled from 2002 to 2012, despite the fact that previous research found no improvement in survival among women who had both breasts removed compared with those who only had the affected breast removed.

In fact, the vast majority of breast cancer survivors do not go on to develop a new breast cancer in the other breast. Furthermore, any potential decrease in risk resulting from CPM does not decrease the possibility of the primary breast cancer metastasizing elsewhere in the body.

Testing positive for BRCA1 or BRCA2 gene mutations

In women who are found to carry the BRCA1 or BRCA2 gene, having a CPM may reduce their risk of developing breast cancer by 95 percent.

Wanting reconstructed breasts to match

Women who have one breast removed may prefer to have both removed if they are going to choose breast reconstruction. It may be hard to make a reconstructed breast look like the natural breast, hence the breasts may "match" better if both are reconstructed at the same time.

Recovering from Surgery

Having one breast removed, depending on the type of the procedure, typically takes two to three hours, hence having both breasts removed will take four to six hours. (If reconstruction is done at the same time, it will take longer.)

Likewise, recovering from a bilateral mastectomy is comparable to recovering from a unilateral mastectomy, except that your risk for complications, such as infection, is doubled. You will have surgical drains on both sides instead of one, and it will take longer for you to fully recover and resume your normal activities.

Post-surgical side effects and complications include:

  • Fatigue: Many people feel tired for days or weeks after the surgery.
  • Pain and stiffness in the arms: The shoulders and arms may be stiff, sore, or otherwise uncomfortable. Medications and exercises can reduce these symptoms.
  • Infection: It is very important to keep your wounds clean and care for your surgical drains properly while recovering.
  • Phantom feelings: Phantom breast pain or numbness can occur after a mastectomy. Prescription medications can often alleviate these symptoms.
  • Lymphedema: If cancer has spread to your lymph nodes, your surgeon will remove them during surgery. This can result in swelling of the arm, known as lymphedema; in some cases this can be permanent.

Call a doctor immediately if you experience swelling, fever, or any other signs of infection.

A Word from Verywell

If you are considering a bilateral mastectomy, be sure to give yourself time to think through both the medical facts and your reasons for making the choice to have both breasts removed.

Keep in mind that some surgeons may not agree to remove both breasts unless a woman has a high genetic risk, or is at high risk of developing cancer in her other breast.

Insurance companies that offer mastectomy coverage must also provide coverage for reconstructive surgery after mastectomy. But there is a chance they may not pay to remove or reconstruct a breast that does not have cancer.

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