If you’re wondering what exactly is a prophylactic bilateral mastectomy, here’s a quick overview from the National Cancer Institute (more info below):
- Preventive mastectomy (also called prophylactic or risk-reducing mastectomy) is the surgical removal of one or both breasts. It is done to prevent or reduce the risk of breast cancer in women who are at high risk of developing the disease.
- Existing data suggest that preventive mastectomy may significantly reduce (by about 90 percent) the chance of developing breast cancer in moderate- and high-risk women.
- Many women who choose to have preventive mastectomy also decide to have breast reconstruction to restore the shape of the breast.
Reducing the risk of breast cancer
About one out of every eight (12.5%) American women will be diagnosed with breast cancer in their lifetime. This chance increases as women age. The risk is higher for women who:
- Carry deleterious mutations of the BRCA1 and BRCA2 genes
- Have strong immediate-family history
- Have high breast tissue density
- Have a personal history of breast cancer
- And other risk factors – some that you can’t control as well as others that you can
The most common type of mastectomy is a simple mastectomy, which removes all of the breast tissue, including the areola and nipple. Versions of this procedure include skin-sparing and nipple-sparing techniques. The type and location of incision depends on which type of mastectomy is planned. The surgery is done under general anesthesia and typically lasts two to three hours (not including reconstruction, which can push it to over 12 hours). Once the breast tissue is removed, the breast surgeon either closes the incision with sutures or staples or steps aside and the plastic surgeon takes over to begin the breast reconstruction. At the completion of the operation, drains are placed to take away excess fluid.
Breast reconstruction can be immediate, delayed, or both (when completed in two stages). Some women choose to use their own tissue and undergo one of the various flap procedures (DIEP, TRAM, GAP, TUG, other) or a fat transfer. Other women opt for the implant route, where saline or silicone breast implants are placed under the skin during the mastectomy surgery. The staged approach involves placing a tissue expander, rather than the breast implant, on the chest wall. Within a few weeks after the surgery, expansion begins by saline injections. Once the expansion process is complete, the exchange of expanders for implants is completed during an outpatient procedure.
Source: Steligo, Kathy. Breast Reconstruction Guidebook: Issues and Answers from Research to Recovery. Maryland: The Johns Hopkins University Press, 2012. Print, third edition.
Choosing breast reconstruction and which procedure is most appropriate is a very personal decision. The information provided here is from my own research and cannot substitute for the advice of a medical professional.