Considering Prophylactic Mastectomy? How to Help Make the Best Decision for Yourself

Woman feeling her breast worrying about her risk when she could get genetic testing

Considering Prophylactic Mastectomy? How to Help Make the Best Decision for Yourself

Finding out you’re at increased risk for future breast cancer due to your family history or a genetic mutation (or both), can be really overwhelming. Here are some steps that may help you come up with a plan that feels right to you and lets you feel more in control of your health and body. First, a genetic counselor and/or high-risk breast specialist can help you really understand your risk of breast cancer and any other cancers that you might have to think about. They can talk to you about screening and prevention plans, which could range from more frequent imaging studies and exams to considering taking hormone-blocking medication or prophylactic mastectomy.

Knowing what your surveillance plan looks like can help you make a decision about if and when you want to think about having prophylactic mastectomies.

Next, if at all possible, find a surgeon who specializes in breast surgery and routinely does mastectomies.  Nearly all women having prophylactic mastectomies are candidates for nipple-sparing mastectomies if they would like to save their nipples, which has been shown in multiple studies to be safe in women at high risk for breast cancer due to family history or genetic mutations.

Depending on your breast shape, size, and goals, nipple-sparing mastectomy might involve an initial breast reduction or lift to make NSM safe at the next surgery. Your breast surgeon can also help connect you to a plastic surgeon if you’re considering breast reconstruction. Keep in mind that there are many different techniques for different types of reconstruction, so take your time asking potential plastic surgeons about the trade-offs of the different procedures and feel free to get multiple opinions if needed to help you feel most informed.

I find one of the most helpful things for making the decision around prophylactic mastectomies is talking with other women who have gone through it. In our office, we are lucky enough to have prior patients who are willing to speak with women considering mastectomy about their experiences, which we offer to coordinate for all of our new patients.

We try to match them with other women who may have similar health or personal situations that could play a role in their recovery – we think of it like a buddy system! There are also some great groups that have fostered communities of women sharing and supporting women through their journey- a couple of our favorites are The Breasties and FORCE.