Prophylactic Mastectomy: Overview

A prophylactic, or preventive, mastectomy is done to remove one or both healthy breasts. It is used to prevent breast cancer in people who have a high risk of getting it.

Having breasts removed before breast cancer strikes does not prevent the disease. Instead, it can lower the risk of breast cancer by at least 90% in individuals who have a high risk. This may be due to prior breast cancer, certain gene defects, or having breast cancer run in your family.

This article describes how to prepare for a prophylactic mastectomy, what it involves, and common outcomes.

What Is a Prophylactic Mastectomy?

A prophylactic mastectomy is an elective surgical procedure to reduce breast cancer risk. While it usually involves the removal of both breasts, it can also be done to remove the remaining healthy breast when cancer is found in the opposite breast.

During a mastectomy, a surgeon detaches the breast tissue from the surrounding muscle and skin and removes it. This tissue lies between the collarbone and ribs, from the breastbone in the center of the body to the side.

The procedure is permanent and irreversible. Because it involves the removal of breast tissue and glands, it changes breast function and sensitivity. In addition, the changes can physically and emotionally impact a woman's sexuality and body image.

Various Surgery Techniques

The type of surgical technique used to perform a prophylactic mastectomy depends on several factors. Your surgeon will discuss the details of your surgery and the technique they plan to use based on your medical history, current condition, and post-surgery goals.

A prophylactic mastectomy is usually performed with one of the following techniques:

• Bilateral simple or total mastectomy: A simple (or total) mastectomy involves the removal of all breast tissue in both breasts, including the nipple, and areola. Muscles and underarm lymph nodes are not removed.
• Skin-sparing mastectomy: A skin-sparing mastectomy removes the nipple, areola, and all breast tissue but leaves most of the breast skin intact. The procedure allows surgeons to preserve a more natural appearance of the breast for breast reconstruction during or after surgery.
  
• Nipple-sparing-mastectomy: Nipple-sparing mastectomy removes all the breast tissue while leaving the skin, nipple, and areola intact.

Some people prefer breast reconstruction at the same time as a prophylactic mastectomy. Your surgeon can discuss your options for this type of combined procedure.

Contraindications

A prophylactic mastectomy can be controversial in people who are not at the highest risk of developing the disease.

Having a healthy breast removed is often discouraged for people at average or slightly elevated risk of breast cancer who have cancer in one breast. The benefits of removing the remaining, or contralateral, breast are not as significant as they are for people at the highest risk. Most people with breast cancer in one breast have a low risk of getting the disease in the other breast.

A prophylactic mastectomy is a permanent and irreversible procedure. Since it prevents breastfeeding, the procedure may not be ideal if you' want to feed your baby this way.

Factors such as age, other medical conditions, lifestyle, mental health, and cosmetic expectations can also determine whether a prophylactic mastectomy or any elective surgery is advised before the disease occurs.

A prophylactic mastectomy includes several risks and complications specific to this type of procedure. These problems can include:

• Hematoma
• Seroma
• Infection
  
• Breast fat necrosis
• Persistent post-mastectomy pain (PPMP)
• Lymphedema
• Phantom breast syndrome
• Scar tissue

Having a prophylactic mastectomy involves the same general surgical risks associated with any invasive procedure.

Potential Risks

Purpose of Prophylactic Mastectomy

The purpose of a prophylactic mastectomy is to reduce the risk of getting breast cancer for people who are predisposed to it.

Removing the breast tissue and glands can greatly reduce but not prevent the possibility of getting breast cancer. Even with removing so much of the breast, it's always possible that some breast cells remain and develop into cancer after the procedure.

A prophylactic mastectomy can reduce the risk of breast cancer by 90% or more in people who have known one or more of the following very high-risk factors:

• A defect in one of the following genes that increase the risk of breast cancer, as proven by genetic testing: BRCA1 or BRCA2, CDH1, PALB2, PTEN, TP53
• Past cancer diagnosis in one breast and high risk of getting cancer in the remaining breast
• A strong family history of breast cancer
• Radiation therapy in the chest area before age 30
• Present or past cancer in one breast with a family history of breast cancer for a high risk of recurrence

How to Prepare

During your consultation with your surgeon, you will receive specific instructions on how to prepare for your prophylactic mastectomy. It is important to closely follow your instructions to support the best possible surgical outcomes.

While your pre-surgical guidelines will be personalized to your needs, common preparations for surgery include the following instructions:

About one month before surgery:

• Complete all required pre-surgical testing
• Complete a healthcare proxy and other advance directives
• Coordinate with a responsible person to bring you home after surgery
• Make advised lifestyle changes which may include eating a healthy diet, drinking more water, and exercising regularly
• Stop smoking, including marijuana
• Limit alcohol consumption as advised

Two to 10 days before surgery:

• Follow instructions from your healthcare provider on changing the dose or stopping medications that may cause excessive bleeding during surgery, including:
• Blood thinners
• Vitamins that can affect blood clotting or bleeding
• Drugs that contain aspirin
• Products that contain vitamin E
• Non-steroidal anti-inflammatory drugs (NSAIDs)
• Pack loose-fitting clothing that doesn't require pulling over your head
• Pack a toothbrush, hairbrush, phone, phone charger, and other personal items you may need for a few days in the hospital

On the day of surgery:

• Stop eating by midnight the night before your surgery
• Do not wear makeup, lotion, nail polish, or deodorant
• Remove and leave jewelry at home
• Shower with an antiseptic skin cleanser if directed
• Stop drinking liquids two hours or longer before surgery as advised
• Take medications as directed
• Allow plenty of travel time to avoid the stress of rushing

What to Expect on the Day of Surgery

A prophylactic mastectomy is a type of major surgery performed at a hospital. Your experience will be similar to having other types of surgery.

You can expect to do the following:

• Register at the admissions office with a photo ID and insurance information
• Wear a hospital gown for the procedure
• Have an IV for fluids and medications before, during, and after surgery
• Undergo a series of checks for blood pressure, heart rate, and other vital signs before surgery
• Have markings made on the breast(s) to indicate where the incision will be made
• Be given anesthesia medication

You will be in surgery from one to three hours for a prophylactic mastectomy. Your total surgery time will take about three to four hours if your procedure includes breast reconstruction with breast implants or breast tissue expanders. It will take about six to eight hours if your reconstruction is done with tissue flaps from your abdominal muscle.

Recovery

After your surgery is complete, you will recover in a post-anesthesia care unit (PACU) of the hospital unit after the anesthesia drugs wear off. You will be moved to a hospital room when you are awake and stable.

It is common to remain in the hospital for one or two nights after a prophylactic mastectomy. However, the length of your hospital will depend on your general condition and the type of surgery you had. If you had breast reconstruction at the same time as your mastectomy, you may stay from two to five nights.

You will have a bandage and dressing over the incision when you leave the hospital. You may also have a surgical drain in place.

Your priority is to rest during recovery so your body can heal. When you leave the hospital, your immediate recovery will likely include the following:

• Instructions for inspecting and changing the incision dressing and surgical drain when present
  
• Instructions for taking pain medication
• Other prescriptions, such as antibiotics, as necessary
• Guidance on how to shower 24 to 48 hours after surgery and protect the incision
  
• Advice to avoid doing strenuous activities and heavy lifting
• Instructions for simple arm exercises to restore arm strength and flexibility
• Recommendations on when to resume driving and return to work
• The need for help to accomplish household tasks

You will likely have a follow-up appointment with your surgeon about two weeks after your mastectomy.

Long-Term Care

Your recovery and long-term care rate will depend on many factors, including your age, general health, and the type of surgery performed. For example, recovery from a mastectomy can take four to six weeks and even longer if you have breast reconstruction surgery simultaneously.

However, it can take several months for your body to adjust to the change. Sensations that occur as a result of damage to sensory nerves damaged during the procedure can produce the following sensations:

• Burning
• Pins and needles
• Numbness
• Persistent, unbearable itching
• Pressure
• Tenderness in the chest and arm

You can expect to continue regular follow-up appointments with members of your healthcare team to monitor your healing. As you heal, your healthcare team will establish a schedule for screening to ensure that any early signs of breast cancer are diagnosed early when treatment is most effective.

If you didn't have breast reconstruction during your prophylactic mastectomy, you may want to consider it after you recover. There are many varieties of prosthetic breasts that may help you feel more like yourself if you choose to avoid breast reconstruction.

Don't ignore your need for emotional healing. A mastectomy performed for any reason can trigger many emotions, including changes in how you see yourself and interact with others. Ask your healthcare provider to recommend ways to cope with feelings of depression or anxiety. Depending on your needs, you may benefit from counseling and/or a support group.

Summary

A prophylactic mastectomy is a surgery that removes one or both healthy breasts. It may be right for you if you have a very high risk of getting the disease due to certain gene defects or having breast cancer run in your family.

A Word From Verywell

If you have a very high risk of breast cancer, it's understandable that you may be willing to do anything to avoid getting the disease. More than 100,000 people annually undergo some type of mastectomy to treat or prevent breast cancer.

While most people who have this procedure report being satisfied with their decision, it's important to explore all your options and their impact on your quality of life before deciding what's right for you. Don't be afraid to seek a second opinion for your condition and recommended treatment.

Ask your healthcare providers to direct you to support groups where you may find people willing to share first-hand perspectives of their experiences. Explore the wide range of in-person and online resources regarding prophylactic mastectomy. Doing so can help you feel comfortable and confident in your decision.