New research out of Wake Forest Medical Center, in Winston-Salem, North Carolina, revealed an interesting trend: Women diagnosed with breast cancer were choosing to have not only the affected breast removed, but also the normal, healthy one — even when they did not carry the gene for developing breast cancer (BRCA).

On the surface this may seem surprising, but in fact, when women opt to undergo a mastectomy for breast cancer treatment, they commonly contemplate undergoing a contralateral mastectomy. Often their physician, a family member, a friend, or another breast cancer patient has suggested it— and there are some advantages, including:

Peace of mind. Even though a woman with breast cancer who does not have the BRCA gene has only about a one percent per year chance of developing breast cancer again in the opposite breast, it may be worth it to her to obliterate that risk altogether. (By contrast, patients with the BRCA gene have an approximate 85 percent lifetime risk of developing breast cancer, as well as a 30- to 50-percent chance of developing ovarian cancer. For that reason, oncologists typically recommend that such women undergo prophylactic removal of the ovaries and either prophylactic mastectomies or close surveillance of the breasts consisting of clinical breast exams every six months and yearly mammograms and MRIs. It’s important to note that mastectomy does not guarantee that a breast cancer patient will remain disease-free: There is always a thin layer of residual breast tissue adherent to the skin which, in approximately 2 percent of patients, could lead to a future breast cancer. Her breast surgeon or oncologist should continue to monitor her skin closely via palpation.

Freedom from future screening. After a double mastectomy, there is no reason for mammography or additional imaging. It’s a relief to many patients that they no longer have to undergo tests that can lead to false positives, needle biopsies, and unnecessary anxiety.

More attractive results. In recent years, reconstruction options have improved dramatically. Depending on the size and location of the tumor, and the size of the breast, many women are able to have mastectomies in which their nipples and areola are left intact. (A traditional mastectomy involves removal of the nipple and areola with delayed nipple reconstruction.) In 2005, the FDA reapproved silicone implants, which feel more natural and have less chance of rippling after surgery than do saline implants. There are also new implant shapes that look more natural than earlier ones, and many flap reconstruction options that allow patients to use their own tissue for breast reconstruction.

Given that there are clear advantages to prophylactic mastectomy, it certainly makes sense for women diagnosed with breast cancer to consider this option for themselves. But the most important thing to remember is that every woman — and every breast cancer — is different, and so there is no one-size-fits-all approach to treatment: Anyone faced with the challenge of deciding how to deal with a diagnosis of breast cancer should make sure she has all the information she needs before deciding how to proceed, and then she should remember what I tell all my patients: “Your decision is the right decision.”

 

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  • Heather Hire September 12, 2012 at 7:13 pm

    I have a strong family history of breast cancer (maternal grandmother, mother, sister, maternal aunts and cousins). My mother was gene tested and it came back negative for the BRCA. I have been in a high risk clinic since my sister was diagnosed at 42. Each appt came more complex resulting in MRI’s every six months often with MRI biopsies. The wait for the results was always uncertain. I opted, on August 29 to have prophylactic double mastectomies along with diep flap reconstruction. The day I made that decision was the first day my mind was at ease and I felt a weight lift off my shoulders. I am in the early weeks of recovery and know it was the best decision I could have ever made.

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  • Debbi OShea January 5, 2012 at 5:41 pm

    Thank you for writing about prophylactic mastectomy options as a rational choice for informed women, with and without a BrCa mutation.

    I was diagnosed at 37 with breast cancer and did not know about my BrCa 1 mutation for another four years. Those were four of the most stressful years of my life! I was fearful of recurrence and dreaded my mammography and ultrasounds months in advance.

    When I found out about my mutation, I opted for bilateral prophylactic surgery. My reconstruction is beautiful. The freedom and peace of mind is priceless.

    People were supportive and understood my choices because I was a bc survivor and had a confirmed mutation. Others, “pre-vivors”, women at high risk who havent had bc, or women who do, and are choosing to have the other breast removed prophylactically are frequently misunderstood as being hysterics.

    Thank you!

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  • Narelle Davis October 5, 2011 at 2:42 am

    When I was working clinically on a surgical ward, I looked after a number of ladies who chose the option of mastectomy and reconstruction. Their decision process, counselling, support they received, and post reconstruction modelling was excellent. One young 28 year old Mum of three stands out in my memory. She had a strong familial history, but as her aim was to see her children and grandchildren grow up, chose this, what I thought, very brave path.

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