What risk-reducing breast surgery involves

When considering this type of surgery, it is very important to know what is involved. To build up a complete understanding you should be able to discuss this with a breast surgeon and a clinical nurse specialist. It will probably also help if you can talk with other women who have had risk-reducing breast surgery.

The breasts

The breasts are made up of fat; connective tissue; and glandular tissue, which contains lobes. A network of ducts connects the lobes to the nipple.

Under the skin, a 'tail' of breast tissue extends to the armpit (axilla). The armpits also contain a collection of lymph nodes (also called lymph glands), which are part of the lymphatic system. There are also lymph nodes just beside the breastbone and behind the collarbones.

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Breast cancer

Breast reconstruction

The operation

During a risk-reducing (prophylactic) mastectomy, the surgeon removes the entire breast with or without the skin and/or nipple. The lymph nodes and underlying muscles of the breast are left intact. However, it is not always clear where the breast tissue ends and other tissue begins; particularly at the lower part of the breast and the part that extends into the armpit  (the axillary tail). This is why it cannot always be guaranteed that all the breast tissue has been removed. The amount of breast tissue that is left behind after risk-reducing mastectomy can vary.

Bilateral risk-reducing mastectomy without reconstruction takes about two hours. The operation takes longer if it includes breast reconstruction.

There are several different procedures used by surgeons when carrying out risk-reducing mastectomy – each woman’s case should be assessed individually and the appropriate surgical options recommended by the breast surgeon.

Tests on the removed breast tissue

After your surgery, samples of the breast tissue that has been removed are sent to a laboratory and examined under a microscope. This is to see if there are any changes in the cells that might be the early stages of cancer. If any cancerous changes are found your doctors will talk to you about any treatment you might need.

Types of surgery

Below are some of the different types of surgery currently used. It is important to discuss these in detail with your surgeon; the surgeon might use slightly different terms to those used here and new techniques might become available that are not mentioned.

Total mastectomy

Also sometimes referred to as simple mastectomy, this involves removing as much of the breast tissue as possible. The nipple (which contains breast ducts), the areola (the coloured skin around the nipple) and most of the skin covering the breast are removed. It cannot be guaranteed that all the breast tissue has been removed; but only a very small amount of breast tissue will be left after this operation, because the whole breast is removed, including its skin.

Skin-sparing mastectomy

This involves removing as much of the breast tissue as possible including the nipple and the areola. The skin covering the breast is not removed, which helps to form the shape of the breast when reconstruction is done.

Subcutaneous mastectomy

This involves removing as much of the breast tissue as possible usually through a cut (incision) in the fold under the breast, leaving in place the skin, the nipple and the areola.

During your consultation, your surgeon will discuss with you the option of keeping the nipple (nipple preservation).

Nipple preservation may be an option when bilateral risk-reducing mastectomy is being considered. However, keeping the nipple and areola leaves a small amount of breast tissue behind. There is a very small risk of cancer developing in that tissue. You should discuss with your surgeon the risks versus the benefits of keeping the nipple and areola in your situation.