Is a Preventive Mastectomy the Right Choice For You?

Written by: Beth Dougherty
Medically Reviewed By: Ann H. Partridge, MD, MPH

A preventive (or prophylactic) mastectomy is the removal of a healthy breast to reduce the chances of developing breast cancer in that breast. A patient might consider a preventive mastectomy under different circumstances, including: 

  • A patient is diagnosed with breast cancer in one breast and considers mastectomy in the other breast, called contralateral prophylactic mastectomy. The patient might be concerned about a recurrence of their existing cancer or the development of a new cancer in that breast. 
  • A patient is found to have an elevated risk of breast cancer, either due to an inherited genetic mutation or previous radiation to the chest, and therefore considers removal of both breasts, called bilateral preventive mastectomy. 

There are many things to consider before deciding. Mastectomy is major surgery, so it is important to understand the risks and benefits.  

According to Dana-Farber’s Ann H. Partridge, MD, MPH, founder and director of Dana-Farber’s Young and Strong Program for Young Adults with Breast Cancer, young women with breast cancer often think that they are at higher risk than they actually are of developing another breast cancer in the other, healthy breast. As a result, they often overestimate the need to have a healthy breast surgically removed.  

However, Partridge and colleagues have found that the 10-year risk of cancer occurring in the healthy breast of young breast cancer survivors without a genetic predisposition to breast cancer is only 2%.  

“The decision about mastectomy should take into consideration the person’s age, the specifics of their breast cancer, the genetic predisposition they have, as well as their personal preferences,” says Partridge. “We are always trying to help our patients get their questions answered and to make sure they understand the ‘why’ behind what we counsel, and also to make sure they feel supported in their preferences.” 

The decision about preventive mastectomy should take into consideration the person's age, the specifics of their breast cancer, the genetic predisposition they have, as well as their personal preferences, according to Dana-Farber’s Ann H. Partridge, MD, MPH, founder and director of Dana-Farber’s Young and Strong Program for Young Adults with Breast Cancer.
The decision about preventive mastectomy should take into consideration the person’s age, the specifics of their breast cancer, the genetic predisposition they have, as well as their personal preferences, according to Dana-Farber’s Ann H. Partridge, MD, MPH, founder and director of Dana-Farber’s Young and Strong Program for Young Adults with Breast Cancer.

What do I need to know about preventive mastectomy if I don’t have breast cancer, but do have a genetic risk of breast cancer? 

A decade ago, the most well-understood genetic mutations that increase the risk of breast cancer were the BRCA1 and BRCA2 genes. Many people who tested positive for these genes chose bilateral mastectomy to prevent breast cancer.  

Now, however, genetic tests for inherited mutations test for several different gene mutations. Some mutations don’t increase the risk of breast cancer as much as others. A conversation with your oncologist and a certified genetic counselor can help you understand your level of risk if you have an inherited breast cancer risk gene and what your options are for prevention and screening. 

What do I need to know about contralateral preventive mastectomy if I have a mastectomy to treat cancer in the other breast? 

Patients might want to consider contralateral mastectomy if they are at a high risk of developing a second primary cancer in the remaining breast; for instance, if they have an inherited genetic risk of breast cancer. Patients might also consider contralateral mastectomy if they undergo mastectomy as treatment for breast cancer and prefer mastectomy in both breasts for symmetry or cosmetic reasons. 

The American Society of Breast Surgeons and Choosing Wisely guidelines recommend against the routine use of contralateral preventive mastectomy among average risk women with breast cancer on one side only.  

When deciding about surgery, it is important to consider your long-term quality of life. Surgical decisions are often made at a time of stress when patients are focused on the cancer and not on things that might be important in the future. Partridge and her colleagues have studied quality of life in patients after breast cancer surgery. They found that young breast cancer survivors who undergo more extensive surgery have worse body image, sexual health, and anxiety compared with those who had less extensive surgery.  

For patients who need a mastectomy, surgical and reconstruction techniques are constantly advancing, and many patients are satisfied with their results. Surgeons can offer immediate reconstruction in some cases, as well as different options for reconstruction. 

Additional considerations are important for patients choosing between mastectomy and lumpectomy for the treatment of breast cancer. 

What tools and support are available to help with decision making? 

Younger patients with breast cancer (diagnosed at age 45 or younger) at Dana-Farber can benefit from services and supportive resources provided by the Young and Strong Program.  

Older patients (age 70 or over, regardless of age at initial diagnosis) at Dana-Farber might benefit from resources provided by the Program for Older Adults with Breast Cancer

A clinical trial called CONSYDER, planned to open at Dana-Farber, Weill Cornell Medicine, Yale Smilow Cancer Center, and Duke Cancer institute, will offer young patients with early-stage breast cancer a decision support tool to help them navigate decisions about surgery in the coming years. 

Peer support can also be valuable. Dana-Farber offers peer support for breast cancer patients through Soulmates. For patients receiving treatment elsewhere, Imerman Angels provides similar connections to peer support groups.  

Patients with uncertainty or anxiety might benefit from a visit with a social worker. Dana-Farber patients can reach a clinical social worker by dialing 1-617-632-3301.  

Is there research looking new ways to reduce the risk of breast cancer? 

Researchers in Dana-Farber’s Center for BRCA and Related Genes, which focuses on biology that is common across multiple forms of cancer, from breast and ovarian to pancreatic and prostate, are investigating options. 

  • Judy H. Garber, MD, MPH, and other researchers in the Center for BRCA and Related Genes are focused on the prevention of breast and ovarian cancer in individuals with BRCA mutations. They are in the early stages of investigating the possibility of safely using PARP inhibitors as preventive medicine for patients at a high risk of breast or ovarian cancer. 
  • Dipanjan Chowdhury, PhD, also in the Center for BRCA and Related Genes, is focused on determining if he can detect breast cancer at its earliest moments using a blood test. Such a test might enable a person with an inherited high risk of breast and ovarian cancer to delay preventive surgery (such as mastectomy, salpingectomy, and oophorectomy) until it is needed. 

About the Medical Reviewer

Ann H. Partridge, MD, MPH

Dr. Partridge received her MD from Cornell University Medical College in 1995. She completed her residency in internal medicine at the Hospital of the University of Pennsylvania and went on to complete fellowships in medical oncology and hematology at DFCI, MGH and BWH. She also received an MPH from Harvard School of Public Health. She is a medical oncologist who cares for adults with breast cancer, with a particular focus on the unique needs of young patients with breast cancer.  She also leads efforts to optimize cancer survivorship care and research at DFCI.