Risk Reduction Surgery for High Risk of Breast Cancer

Risk-reduction surgery, also known as prophylactic mastectomy, is a preventive surgical procedure for individuals at high risk of developing breast cancer. This includes those with a strong family history of breast cancer, confirmed gene mutations (e.g., BRCA1, BRCA2), or other high-risk factors.

Indications

You may consider risk-reduction surgery if you have:

  • A genetic mutation associated with a high risk of breast cancer (e.g., BRCA1, BRCA2, TP53, PTEN, PALB2)

  • A strong family history of breast cancer (multiple relatives affected, especially at a young age)

  • A history of lobular carcinoma in situ (LCIS) or atypical hyperplasia

  • Prior radiation therapy to the chest at a young age

Surgical Techniques

There are different surgical approaches for risk-reduction mastectomy, including:

  1. Total (Simple) Mastectomy – Removal of the entire breast tissue, including the nipple and areola.

  2. Nipple-Sparing Mastectomy – Removal of breast tissue while preserving the nipple and areola for a more natural cosmetic result.

  3. Skin-Sparing Mastectomy – Removal of breast tissue while keeping most of the skin intact, often used with breast reconstruction.

Breast reconstruction can be performed simultaneously or in a delayed manner using implants or autologous tissue (fat or muscle from other body parts).

Post-Operative Care

  • Hospital Stay: Typically 1-2 days, but may vary depending on the type of surgery and reconstruction.

  • Pain Management: Pain medication will be prescribed to manage discomfort.

  • Drain Care: Surgical drains may be placed to remove excess fluid. These are usually removed within 1-2 weeks.

  • Activity Restrictions: Avoid heavy lifting and strenuous activities for at least 4-6 weeks.

  • Wound Care: Keep the incision sites clean and dry. Follow your surgeon’s instructions for dressing changes.

  • Follow-up Appointments: Regular check-ups are necessary to monitor healing and detect any complications.

  • Support: Emotional support, counselling, and support groups can help adjust to the changes.

Risk-reduction surgery is a personal decision that should be made after thorough discussions with your healthcare team, including a breast surgeon if reconstruction is planned. While it significantly lowers the risk of developing breast cancer, it is essential to weigh the benefits, risks, and emotional considerations before proceeding.