The pros and cons of having a preventive mastectomy

    You might consider this risk-reduction surgery if you have a mutation in the BRCA1 or BRCA 2 gene.

    You probably remember Angelina Jolie’s 2013 New York Times op-ed on her choice to have a preventive mastectomy after genetic testing revealed she had a mutation in the breast cancer gene, more formally known as the BRCA gene.

    Jolie’s testimonial raised awareness for genetic testing, and according to research, her op-ed led to an increase in BRCA gene testing among women aged 18 to 64. It’s estimated that 4,500 more BRCA tests were given that would have normally occurred during that time. While this “celebrity endorsement” did not lead to any more mastectomies, it did spark important conversations across the country about the ups and downs of preventive mastectomies.

    What is a preventive mastectomy?

    Women who have a very high risk of breast cancer often opt to have preventive surgery to remove both breasts—this is called a mastectomy, and there are two kinds, says the National Cancer Institute. The most common is called a bilateral prophylactic mastectomy (or a bilateral risk-reducing mastectomy). This involves complete removal of both breasts (including the nipples). Some doctors may perform a subcutaneous mastectomy (or a nipple-sparing mastectomy), which means as much breast tissue as possible will be removed while still leaving the nipples intact. This allows for more natural-looking breasts if the woman chooses to have breast reconstruction surgery afterward.

    You might consider this risk-reduction surgery if you have a mutation in the BRCA1 or BRCA 2 gene (around 70 percent of women with the BRCA gene will develop breast cancer at some point in their lives, but there’s no way to know for sure if you’ll be one of them, says the American Cancer Society).

    The American Cancer Society says you should also consider the surgery if you have a strong family history or breast cancer, have a history of lobular carcinoma in situ, had radiation therapy to the chest before age 30, or have (or had) cancer in one breast.

    The pros are obvious, right?

    According to the National Cancer Institute, this surgery has been shown to reduce the risk of breast cancer by at least 95 percent in women who have a disease-causing mutation in the BRCA1 or the BRCA2 gene.

    For many women who have tested positive for the BRCA mutation or who have a strong family history of breast cancer, a preventive mastectomy can put many fears about the future at ease.

    What’s the downside?

    As with many major surgeries, a preventive mastectomy can have complications, such as bleeding, infection, fluid build-up, delayed wound healing, and formation of scar tissue.

    When it comes to long-term risks, names a few:

    • Women who undergo this surgery will suffer a significant loss of sensation in the breast, which can have a big impact on a woman’s intimacy.
    • If the woman has the operation while she is still of child-bearing age, she will not be able to breastfeed any future babies.
    • There’s a risk for anxiety or depression about body image after a mastectomy or breast reconstruction.
    • Your insurance may not cover a preventive mastectomy.
    • And even though a preventive mastectomy reduces the risk for cancer by 95 percent, it’s still not a 100 percent guarantee.

    Are there other options?

    Discussing every option for risk reduction with your doctor is important. If you’re at higher than average risk for breast cancer, but a preventive mastectomy isn’t for you, there are other ways to lower your chances of getting this disease.

    • While routine breast cancer screening is essential for all women, it’s even more so for high-risk women, says Susan G. Komen. This could mean starting breast cancer screenings earlier and more often than other women. Speak with your healthcare provider to create a personalized plan.
    • Chemoprevention drugs, like tamoxifen and raloxifene, are commonly used to prevent breast cancer. According to Susan G. Komen, both drugs reduce the risk of estrogen receptor-positive breast cancer. But, both come with long-term side effects. Talk to your doctor about the potential harms and benefits of each.

    This article is for informational purposes only and is not intended to diagnose or treat any condition. If you have any concerns, please speak with your doctor.

    Sinclair Broadcast Group is committed to the health and well-being of our viewers, which is why we initiated Sinclair Cares. Every month we’ll bring you information about the “Cause of the Month,” including topical information, education, awareness, and prevention. October is Breast Cancer Awareness Month.

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