Definition: Prophylactic preventative mastectomy is the surgical procedure performed to remove one or both breasts to prevent or reduce the risk of developing breast cancer.
Women who are at high risk of developing breast cancer often consider and decide to reduce their risks by undergoing prophylactic – or risk reducing mastectomy as it is also called. In a total mastectomy the surgeon removes the entire breast and nipples. In a subcutaneous mastectomy, the breast tissue is removed but the nipple is left intact. A total mastectomy is most often recommended because it removes the most tissue – thereby providing the greatest degree of protection against developing breast cancer. Reasons women choose this surgery include:
- Previous breast cancer – if a woman has had breast cancer in one breast, the risk of developing it in the other breast is greater.
- Family History of breast cancer- risk of developing breast cancer is greater for women with a mother, sister or daughter who have had breast or ovarian cancer.
- Breast cancer-causing gene alteration – a woman who tests positive for changes, or mutations, in certain genes that increase the risk of breast cancer such as BRCA1 or BRCA2 gene may consider prophylactic mastectomy.
- Lobular carcinoma in situ- this condition increases the risk of developing breast cancer in either breast.
- Radiation therapy – women who have been treated for Hodgkin’s lymphoma are included in this group - among women who have had radiation therapy to the chest before age 30. These women are at increased risk for developing breast cancer throughout life.
- Severe Fibrocystic Disease with precancerous characteristics – places women with this painful disease at higher risk for developing breast cancer. Other treatment efforts have failed and physicians recommend mastectomy.
These surgeries can often be performed on an out-patient basis. It involves removal of the majority of breast tissue and immediate first stage reconstruction using temporary breast expanders which are later replaced with permanent implants. Dr. Lettieri then creates a nipple tattoo and nipple reconstruction is done later at the appropriate time.