Prophylactic Mastectomy - is it right for you?

Having prophylactic mastectomy is a very personal choice. There is no "right answer", only what you consider is best for you.

Women who are at high risk of developing breast cancer have the option of prophylactic (preventive) mastectomy as a way of decreasing their risk. Factors that increase a woman’s chance of developing breast cancer include:

1. a genetic predisposition to breast cancer e.g. BRCA+, Cowden's Syndrome, Li-Fraumeni Syndrome
2. a strong family history of breast cancer
3. a breast cancer diagnosis at a young age
4. abnormal breast cells on biopsy that increase the risk of breast cancer, e.g. LCIS
5. a history of previous chest radiation, e.g. treatment for Hodgkin's Lymphoma

Prophylactic mastectomy decreases the risk of future breast cancer by 97-99%. Since the breast tissue is removed, the surgery also removes the need for regular screening mammograms/MRIs and preventive drugs like tamoxifen.

Surgery is not the only option however. Many women prefer close monitoring and preventive drugs (known as "chemoprophylaxis").

Regardless of other choices, all women should modify their diet wherever possible to decrease their risk. It is vital you discuss all your options and the pros, cons, and risks of each before making the best decision for you.

If you choose prophylactic surgery please remember that you can also have breast reconstruction at the same time as mastectomy. There is no need to experience having a flat chest unless you specifically decide you wish to remain without breasts.

You have several reconstructive options and the results can be very natural and cosmetic. If you choose to undergo breast reconstruction at the same time, a "skin-sparing" mastectomy is usually performed. This saves all the breast skin envelope which significantly adds to the cosmetic results without increasing your risk of cancer. In many cases, the nipple-areola can be saved too. This is known as a "nipple-sparing" mastectomy.

Thankfully, most insurance plans cover the cost of prophylactic mastectomy and reconstruction in high risk patients but you will have to check with your individual plan to make 100% sure.

I hope this info helps.

Dr C

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PRMA Plastic Surgery specializes in state-of-the-art breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap, Alloderm One-Step and fat grafting. We are In-Network for most US insurance plans and routinely welcome patients from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer patients at facebook.com/PRMAplasticsurgery.

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Nipple-Sparing Mastectomy

Nipple-sparing mastectomy in conjunction with immediate breast reconstruction is becoming more and more popular so I thought a blog post about it was in order...

What is a nipple-sparing mastectomy?

A nipple-sparing mastectomy preserves the nipple,  areola and all the surrounding breast skin which is then used for the breast reconstruction. Unlike the traditional "modified radical mastectomy", nipple-sparing mastectomy only removes the breast tissue ("parenchyma") under the skin.

What are the benefits?

Studies show that nipple-sparing mastectomy provides the same level of surgical treatment as a modified radical mastectomy in appropriate candidates. Preserving the nipple-areola complex adds to the quality of the reconstruction making the results even more "natural". It also means the patient avoids having to go through the additional steps of nipple reconstruction and tattooing.

Who is a candidate?

Nipple-sparing mastectomy is an option for many patients with a small cancer located several centimeters away from the nipple-areola complex. Patients with ductal carcinoma in situ (DCIS) can also be candidates, again depending on the location and distance from the nipple-areola.

During the surgery, a biopsy ("frozen section") is taken from behind the nipple-areola complex and sent to pathology to make sure there is no cancer under the nipple or areola. If this biopsy is negative then the area can be preserved. If it is positive for cancer cells, the nipple and areola are obviously removed.

Patients at high risk of breast cancer (eg BRCA+, strong family history, Cowden's syndrome) choosing to undergo prophylactic (preventive) mastectomy and immediate breast reconstruction are the best candidates.

Patients who do not need a signficant breast lift will have the best cosmetic results.

What are the risks?

Nipple sensation is usually significantly reduced. Sometimes feeling is lost completely. Even in cases where some nipple-areola sensation is maintained, it is very unlikely the feeling will be as Mother Nature provided.

The underside of the nipple and areola is "shaved down" to remove as much of the breast tissue as possible. This can sometimes compromise the blood supply to the tissue which can then cause healing problems. If the blood supply is damaged too much by the mastectomy, part or all of the nipple-areola can die. Thankfully this is uncommon.

At PRMA we check the blood flow intra-operatively to ensure the nipple-areola will survive. In the unlikely event that the nipple-areola cannot be saved, it is removed to prevent wound healing complications and a new nipple and areola are reconstructed at a later time.

Where will the scars be?

This depends on the size and shape of the breast, whether a small "lift" is needed, patient preference and surgeon preference. Scars can be placed around part of the areola and extended outwards or downwards, or completely away from the areola at the breast crease ("inframmamary fold incision").


I hope this info helps!

Dr C

*****

Dr Chrysopoulo specializes in advanced breast reconstruction including DIEP flap, SIEA flap, GAP flap, TUG flap, Alloderm One-Step and fat grafting. He is in-Network for most US insurance plans. Patients are routinely welcomed from across the USA. Please call (800) 692-5565 or email patientadvocate@PRMAplasticsurgery.com to learn more about your breast reconstruction options. Connect with other breast cancer patients at facebook.com/PRMAplasticsurgery.

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