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1. What is preventive mastectomy, and what types of procedures are used in preventive mastectomy?

Preventive mastectomy (also called prophylactic or risk-reducing mastectomy ) is the surgical removal of one or both breasts in an effort to prevent or reduce the risk of breast cancer. Preventive mastectomy involves one of two basic procedures: total mastectomy and subcutaneous mastectomy. In a total mastectomy, the doctor removes the entire breast and nipple. In a subcutaneous mastectomy, the doctor removes the breast tissue but leaves the nipple intact. Doctors most often recommend a total mastectomy because it removes more tissue than a subcutaneous mastectomy. A total mastectomy provides the greatest protection against cancer developing in any remaining breast tissue.

2. Why would a woman consider undergoing preventive mastectomy?

Women who are at high risk of developing breast cancer may consider preventive mastectomy as a way of decreasing their risk of this disease. Some of the factors that increase a woman's chance of developing breast cancer include the following:

• Previous breast cancer -- A woman who has had cancer in one breast is more likely to develop a new cancer in the opposite breast. Occasionally, such women may consider preventive mastectomy to decrease the chance of developing a new breast cancer.



• Family history of breast cancer -- Preventive mastectomy may be an option for a woman whose mother, sister, or daughter had breast cancer, especially if they were diagnosed before age 50. If multiple family members have breast or ovarian cancer, then a woman's risk of breast cancer may be even higher.



• Breast cancer-causing gene alteration -- A woman who tests positive for changes, or mutations, in certain genes that increase the risk of breast cancer (such as the BRCA1 or BRCA2 gene) may consider preventive mastectomy.



• Lobular carcinoma in situ -- Preventive mastectomy is sometimes considered for a woman with lobular carcinoma in situ, a condition that increases the risk of developing breast cancer in either breast.



• Diffuse and indeterminate breast microcalcifications or dense breasts -- Rarely, preventive mastectomy may be considered for a woman who has diffuse and indeterminate breast microcalcifications (tiny deposits of calcium in the breast) or for a woman whose breast tissue is very dense. Dense breast tissue is linked to an increased risk of breast cancer and also makes diagnosing breast abnormalities difficult. Multiple biopsies, which may be necessary for diagnosing abnormalities in dense breasts, cause scarring and further complicate examination of the breast tissue, by both physical examination and mammography.



• Radiation therapy -- A woman who had radiation therapy to the chest (including the breasts) before age 30 is at an increased risk of developing breast cancer throughout her life. This includes women treated for Hodgkin's lymphoma.

It is important for a woman who is considering preventive mastectomy to talk with a doctor about her risk of developing breast cancer (with or without a mastectomy), the surgical procedure, and potential complications. All women are different, so preventive mastectomy should be considered in the context of each woman's unique risk factors and her level of concern.