Have you ever heard of a breast reduction surgery, where one or both breasts are removed before they develop, to reduce your risk of developing breast cancer? While this may sound new and a little scary to you, it is actually a very important medical option that can save your life for some women who are at very high risk of developing breast cancer. This is a very personal decision. So, today we will talk about this, that is, 'Prophylactic Mastectomy', in a simple way that you can understand.
Simply put, what is Prophylactic Mastectomy?
Although the name may sound complicated, the concept is simple. Prophylactic Mastectomy is the surgical removal of a healthy breast or both breasts before cancer develops, with the aim of reducing the risk of breast cancer.
Simply put, this is a "preventive mastectomy." Some people also call it a 'preventative mastectomy' or 'risk-reducing mastectomy.' This is done to reduce the risk of developing cancer in the future, rather than to treat it if it already exists.
Who should consider this surgery? Does everyone need this?
No, definitely not. This surgery is not suitable for everyone. Someone with average risk should not even consider this type of surgery. Your doctor will only suggest this option to you if it is confirmed that you have a very high risk of developing breast cancer.
Okay, so let's see what those high risk factors are.
- Having a strong family history of cancer: If a close relative (for example, your mother, sister, or daughter) has had breast cancer, your risk is significantly increased. This is especially true if that person developed the cancer before the age of 50 .
- Having a personal history of cancer: Imagine that you already have cancer in one breast, and you need to have a mastectomy to remove that breast as a treatment. At that time, some people decide to have the other healthy breast removed as well, to reduce the risk of developing cancer on that side in the future. However, this does not affect the status of the existing cancer or any additional treatments that may be given to it.
- Positive Genetic Testing: Changes or mutations in certain genes in our body can greatly increase the risk of developing cancer. BRCA1 and BRCA2 are two such major genes. If a genetic test confirms that you have one of these genetic mutations, your risk of developing breast cancer is very high. In such a case, you may consider this surgery.
- Radiation therapy in the past: If you have had radiation therapy to the chest area for any reason, especially between the ages of 10 and 30 (for another cancer, such as Hodgkin's lymphoma), your risk of developing breast cancer in the future may be increased.
This is a very important thing. This decision is not something you should make alone. You should talk to your doctor, surgeon, and your family very carefully and understand all the pros and cons before making a decision.
How much does this surgery actually reduce the risk?
This is the most important question. Yes, the safety of this surgery is very high for those at high risk. Studies have found that:
- This surgery can reduce the risk of breast cancer in women with a BRCA1 or BRCA2 gene mutation by about 95% , meaning the risk is almost completely eliminated.
- Women with a strong family history of cancer can reduce their risk by about 90% .
This is a really high percentage, which is why it is a good option for those in the high-risk category.
Are there different types of this surgery?
Yes, there are several different ways to perform this surgery depending on the patient's needs, body type, and doctor's recommendation. Let's understand it clearly from this table.
| Type of surgery | Simple description |
|---|---|
| Bilateral Mastectomy | This involves the complete removal of both breasts. This method is often chosen by those with genetic risk factors. |
| Contralateral Mastectomy (opposite) | This is called a mastectomy, which is when a person with cancer in one breast has the other healthy breast removed at the same time that that breast is removed. |
| Skin-Sparing Mastectomy | Here, the nipple and the dark area around it (areola) are removed, and only the breast tissue inside is removed through that small incision. Most of the skin of the breast is left behind. |
| Nipple-Sparing Mastectomy | In this method, only the breast tissue inside is removed, leaving the nipple and the area around it intact. |
| Mastectomy with Reconstruction | Breast reconstruction surgery is performed at the same time as or after mastectomy. This can be done using silicone implants or tissue taken from another part of the body (e.g., the abdomen). |
What happens before and during the surgery?
Your doctor will give you all the necessary instructions before the surgery. On the day of the surgery, you will be put in a hospital gown and have an IV line connected to your arm. This will put you under general anesthesia, meaning you will not feel anything during the surgery and will be completely asleep.
Then they take him to the operating room, and the surgeon begins the operation.
1. First, an incision is made in a suitable place on the breast.
2. Then, the breast tissue is carefully separated from the skin and chest muscles.
3. The removed breast tissue is completely removed. If you are planning to have breast reconstruction, that step can begin at this time.
4. After surgery, several tubes called drains are placed to drain excess fluid (blood, water, etc.) that accumulates inside the wound. These are removed in a few days.
5. Finally, the incision is stitched and covered well with a bandage.
This surgery usually takes about two to three hours, but if breast reconstruction is also being done at the same time, it may take longer.
What happens after the surgery? How long does it take to recover?
You will need to stay in the hospital for about a day after the surgery. This time may vary depending on your health condition and whether you had reconstructive surgery.
During your recovery, the medical team will recommend simple exercises to help reduce stiffness and tightness in your arms and shoulders.You will be taught. These exercises will also reduce the formation of scar tissue. Before you leave the hospital, you will be explained everything, such as how to care for the wound at home and how to take medication.
Recovery Time:
- It usually takes about 3-4 weeks for initial healing .
- If you have had breast reconstruction surgery, it can take up to 8 weeks to heal.
- It may take several months before you can resume all your normal activities, especially things like lifting weights.
What are the risks and complications of this surgery?
Like any surgery, this one has some risks.
- Bleeding
- Infection
- Loss of sensation in the breast and nipple
In addition to these physical risks, there is another important thing to consider: the psychological impact .
You may feel anxious and sad about your body after surgery. Losing one or both of your breasts can be emotionally difficult to cope with. This is very normal. Don't fight these feelings alone. It can be very helpful to talk to a psychiatrist or counselor who can help you talk about this and help you come to terms with it.
When should I see the doctor after surgery?
If you experience any of the following symptoms after going home from surgery, you should call your doctor immediately .
- If you develop a fever .
- If the wound is bleeding .
- If the pain does not subside after several weeks or if it gets worse.
- If there is redness and swelling around the wound.
- If you feel warmth around the incision.
These could be signs of an infection, so it is very important to report them quickly.
Take-Home Message
- Prophylactic Mastectomy is not a surgery for everyone. It is only done for those who are at very high risk of developing breast cancer.
- If performed on the right person, this surgery can reduce the risk of breast cancer by 90-95%.
- There are various methods of performing the surgery, and there is also the option of breast reconstruction either at the same time as or after mastectomy.
- It takes time to heal both physically and mentally. It's normal to feel sad and anxious as your body changes. Don't hesitate to seek help from a mental health professional.
- This is a very big and personal decision that will affect your life. Therefore, talk to your doctor about it carefully, understand all the pros and cons, and make the decision that is right for you.
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