A risk-reducing mastectomy is surgery to remove a woman’s breasts when there is no sign of breast cancer and there is a significant increase risk for developing breast cancer. This surgery is also called preventative or prophylactic bilateral mastectomy. It can prevent breast cancer from developing because nearly all of the breast tissue will be removed. If you are at higher than average risk for developing breast cancer, you may want to consider this option.

How much can this surgery decrease my risk of breast cancer?

For women with a BRCA mutation, surgically removing both breasts can reduce the risk of developing breast cancer by 90%.[1]

Can I still get breast cancer after a risk-reducing mastectomy?

As it is not possible to remove every breast cell during surgery, there is a very small chance that breast cancer could still develop after a risk-reducing mastectomy. Because some breast tissue remains after a risk-reducing mastectomy, your doctor may still offer you breast screening. Breast screening after mastectomy is done through regular physical exams. Mammograms or MRIs are generally not done after risk-reducing mastectomy because there is not enough breast tissue to examine. However, your doctor may still want to do a regular physical exam of the area.

Risk-reducing Oophorectomy

Removal of the ovaries (oophorectomy) also significantly reduces the risk of breast cancer in BRCA mutation carriers.[2] Learn more about risk-reducing oophorectomy

What is the recommended age for this surgery?

There is no specific age to have a risk-reducing mastectomy. If you are considering this option, understanding your personal risk of breast cancer will help you determine the ideal time to undergo surgery. There are many factors to consider including:

  • your age
  • your family history of breast cancer
  • whether you have had a diagnosis of breast cancer
  • whether you are still planning to breastfeed

Your genetic counsellor or doctor can help you better understand your personal risk of breast cancer and when you might want to have a risk-reducing mastectomy

 What does a risk-reducing mastectomy involve?

A risk reducing mastectomy is performed by a general surgeon or breast surgeon. All the tissue in both of your breasts (or as much as possible) is removed in a risk-reducing mastectomy. Breast tissue includes glandular tissue (the lobules and ducts that produce and deliver milk), as well as fatty and connective tissue.


breast_anatomy_diagram


mastectomy_diagram


 

There are three main types of risk-reducing mastectomy:

skin-sparing-mastectomy-diagram  
Skin-sparing mastectomy

During skin-sparing mastectomy the nipple and areola are removed. Most of the skin surrounding the breast is not removed. The breast tissue is removed through the small incision around the nipple and areola. This method is only used when you are having breast reconstruction on the same day.


nipple-sparing-mastectomy

Nipple-sparing mastectomy

In some cases it is possible to remove the majority of the breast tissue while still keeping the nipple. All of the breast tissue, including the ducts going all the way up to the nipple and areola, are removed. Keeping the nipple means that there may be a small amount of breast tissue left. The surgeon can remove the breast tissue through a small incision in the outer part of the breast, in the fold under the breast or around the areola. Talk to your breast surgeon about where the incision will be.


total-mastectomy-diagram

Total mastectomy (also known as Simple Mastectomy)

During simple or total mastectomy, the nipple, areola, some of the overlying skin and all of the breast tissue are removed. This may be a choice if you are not considering immediate breast reconstruction. It is still possible to have reconstruction at a later time following a simple mastectomy.


making decisions at your own pace

Having a BRCA mutation does not mean that you have to have a risk-reducing mastectomy. Having a risk-reducing mastectomy is a choice you have to make for yourself. Whatever decision you make, take your time. You will feel better about your choice if you do not feel pressured to quickly make a decision.

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Are you struggling with your decision
about risk-reducing mastectomy?

work through our interactive
decision making website

making your
decision about

risk-reducing
mastectomy

a decision-making guide
for women at high risk
of breast cancer

scale_sm

making your
decision about

risk-reducing
mastectomy

a decision-making guide
for women at high risk
of breast cancer


Can I have breast reconstruction following a mastectomy?

Some women may prefer to remain breast-free or wear breast prostheses (external breast forms that fit into a bra). However, breast reconstruction is an option that is available to most women who will have or have had a mastectomy. Breast reconstruction is performed by a plastic surgeon. It is usually done at the same time as risk-reducing mastectomy (immediate reconstruction), but it can be done at a later date (delayed reconstruction). The appearance of reconstructed breasts is usually better when reconstruction is done immediately. Most women who have breast reconstruction are satisfied with the results. One important thing to know about reconstructed breasts is that they do not have the same appearance or sensation as natural breasts. This lack of sensation in your reconstructed breasts can be difficult to adapt to.

Learn more about your breast reconstruction options.

Do I need to pay for a risk-reducing mastectomy and reconstruction?

No. At this time, both risk-reducing mastectomy and breast reconstruction surgery for high-risk women are covered by provincial health insurance plans. These surgeries are also covered for women who have had breast cancer.

How soon can I have surgery?

Wait times vary depending on where you live in Canada and whether you chose to have a risk-reducing mastectomy alone or with immediate breast reconstruction. You may have to wait a little longer if you are having a mastectomy with immediate reconstruction because it requires scheduling a plastic surgeon and a breast surgeon to be available at the same time.


What is it like to have a risk-reducing mastectomy?

The best way to find out what it is like to have a risk-reducing mastectomy is to talk to women about their experiences. To talk to a woman who has had this surgery, call Willow at 1-888-778-3100 or email support@willow.org

What is it like to have a risk-reducing mastectomy?
How a woman may feel before a risk-reducing mastectomy

Natalie talks about her struggles with anxiety before her mastectomy

Read the transcript

In the months leading up to my mastectomy, I had a lot of anxiety…But what I found was, it was really difficult before, but afterwards there was a sense of relief, that it was over.

Natalie
Natalie was grieving the impending loss of her breasts before having surgery. Grieving for a loss that is soon to occur is called anticipatory grief. This feeling is normal and may intensify as your surgery date nears. After surgery this feeling may persist or, like Natalie, you may feel a sense of relief. For some women, these feelings may intensify the closer they get to their surgery date. However, for women like Natalie, there is a great sense of relief after surgery. Overall, most women eventually come to accept their new body. Try to remember that this process takes time.


What is it like to have a risk-reducing mastectomy?
Women’s experience of risk-reducing mastectomy

Lara, Tracy, and Andrea talk about their experience of surgery

Read the transcript

It will take time for you to physically and emotionally heal after surgery. Some parts of the surgical process might be distressing for you. Lara felt disturbed by the surgery prep work. Tracy felt disappointment when she couldn’t have a same-day reconstruction. Andrea had to push herself to start her recovery after the surgery. Though recovering from surgery is stressful and difficult, most women do not regret their decision to have a mastectomy.


What is it like to have a risk-reducing mastectomy?
Women’s feelings after thier risk-reducing mastectomy

Natalie, Melissa, and Andrea talk about how they feel now having had a risk-reducing mastectomy

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…if I could go back in time, I would do the exact same thing, the exact same preventive surgery and reconstruction.

Andrea
After a risk-reducing mastectomy most women feel relief that they no longer have to worry about their cancer risk. Deciding to have a risk-reducing mastectomy may remind some women of the losses in their family from breast cancer. Even women who felt well-prepared for the surgery and after had no regrets, have said that it takes time and energy to get used to their new body after a risk-reducing mastectomy and reconstruction.

I don’t worry about my risk of cancer anymore. I’ve done what I can to reduce my risk, and now it’s out of my hands.

Natalie

If you would like to listen to more women talk about how they felt about their bodies after a risk-reducing mastectomy and reconstruction, read through after mastectomy.


Making your decision on whether or not to have a risk-reducing mastectomy

Tori and Tracy talk about making tough decisions

Read the transcript

It is a difficult decision to have a mastectomy when there is no sign of breast cancer. When making her decision Tori needed to think about how she would feel looking down and knowing that she would not be seeing her original breasts. After seeing her mom struggle with cancer, Tracy knew that reduction of her cancer risk was the most important issue for her when making her decision. There is no right or wrong decision. The best choice for you depends on the issues that are most important to you. It is important not to feel rushed to make this decision. Take as much time as you need to feel good about your choice

scale_sm

Are you struggling with your decision
about risk-reducing mastectomy?

work through our interactive
decision making website

making your
decision about

risk-reducing
mastectomy

a decision-making guide
for women at high risk
of breast cancer

scale_sm

making your
decision about

risk-reducing
mastectomy

a decision-making guide
for women at high risk
of breast cancer