Making your decision about risk-reducing breast surgery

Risk-reducing breast surgery can greatly reduce your risk of developing breast cancer but it is a big step. Not all women with a high risk of breast cancer develop it. You will need time to make your decision.

Many women say, after having risk-reducing surgery, they feel much less anxious about getting breast cancer and how it could affect their family. But your body won’t look or feel the same and this may affect your sex life.

Health professionals, such as a genetic counselor, psychologist, breast surgeon and clinical nurse specialist, can discuss the advantages and disadvantages of surgery with you. They can also explain the other options for managing your risk of breast cancer. Your surgeon can also show you photographs of women who have had similar surgery. It can be helpful to include your partner or a close family member or friend in these discussions.

You may find it helpful to speak to other women who have had the operation. Your hospital team may be able to arrange this.

Making your decision about risk-reducing breast surgery

Deciding whether or not to have risk-reducing breast surgery is not easy. You may need lots of time to help you make up your mind, so try not to feel rushed into making a decision.

The breast unit at the hospital should have a written procedure (protocol) for the care and support of women considering this type of surgery. If a protocol is not obviously available in your hospital, don’t be afraid to ask to see it to help you make a fully informed decision.

You may find it helpful to hear about the experiences of other women who are, or have been, in the same situation as you. Your hospital team may be able to put you in touch with someone willing to share their experiences. However, it’s important to remember that everyone is different, so what was right for one woman may not be right for you. It’s important to do what feels right for you and to take as much time as you need to make your decision.

If you’re concerned about the impact that developing breast cancer might have on your family, remember this will be greatly reduced by having risk-reducing surgery. And, you won’t have to go through the worry of wondering if you have cancer every time you have screening tests. In fact, you’ll no longer need routine screening tests after surgery.


Your appearance after risk-reducing breast surgery

Many women are concerned about how they will look after risk reducing breast surgery. They worry it will make them less attractive and may affect their relationships with others, particularly if they have a partner.

It can take time to adjust to your new appearance after surgery and this can be harder for some women than for others. Sharing your feelings and concerns with someone you trust such as a close friend or your partner can help.  It’s important to remember that you will still be you, even if your appearance has changed due to surgery.

It may help to write down what you see as the benefits and disadvantages of having surgery to help you decide what’s right for you.


Advantages and disadvantages of risk-reducing surgery

Advantages

  • The operation greatly reduces your risk of breast cancer (by about 95%).
  • After the operation most women say they feel much less anxious about getting breast cancer and about the impact it could have on their family.
  • You won’t need to have breast screening.

Disadvantages

  • After the operation it can take up to six months or more to fully recover.
  • As with all operations there can be complications.
  • Your body won’t look the same and you may not be happy with the change in your appearance. Some women feel less confident sexually.
  • You may not develop breast cancer anyway, even if you don’t have the operation.
  • The results of the surgery are permanent. You can’t change your mind once you’ve had the operation.
  • If you are having breast reconstruction as well, you’re likely to need more than one operation to get the best cosmetic result.

If you don’t want to have a prophylactic mastectomy or you aren’t ready to make that decision, you can talk with your geneticist or hospital team about other options.


Questions to ask your breast surgeon

Most breast surgeons who do this type of surgery will see you at least twice before you have to make a decision about whether or not you want to have risk-reducing breast surgery. They will answer your questions and discuss any anxieties.

You may also be able to look at photographs of women who have already been operated on by your surgeon, or to speak to other women who have had similar surgery.

You will also have the support of a clinical nurse specialist and a counsellor or psychologist associated with the breast clinic. They can give you further information and support to help you to make an informed decision.

It often helps to have a list of questions to ask your breast surgeon. This can help you gather the information you need before you decide what to do. Here are some suggestions:

  • What type of surgery do you think would be suitable for me and why?
  • What are the possible complications/risks of the surgery?
  • Where will cuts be made and what might the scars look like?
  • How long will it take for me to get over the operation?
  • If I decide to have risk-reducing mastectomy, what is the best age to have it done?
  • If I decide to have surgery, how long would I have to wait to have it done?
  • Could I talk to someone who has already had a risk-reducing mastectomy?
  • Can I talk to somebody about the possible emotional effects of having a risk-reducing mastectomy?
  • If I decide not to have breast reconstruction, is there anyone who can give me advice about breast prostheses, bras and swimwear etc?
  • What type of support will be available to me after the operation? This is just as important as support offered before the operation.
  • If you are thinking about breast reconstruction, you may want to ask further questions:
  • If I decide to have breast reconstruction, when would you advise me to have it done?
  • What type of breast reconstruction would you advise me to have?
  • Can you tell me about the options for nipple reconstruction?


Your feelings about risk-reducing breast surgery

How you feel about risk-reducing breast surgery will depend on many things, such as your risk of developing breast cancer, your experience of breast cancer within your family and how you feel about your breasts. If you have a partner, their feelings may also be important. It can be helpful to involve your partner or a close friend in the discussions about the risks and benefits of this type of surgery.

Other things that may influence your decision are your cultural and religious beliefs, as well as your level of fitness and general wellbeing.

It’s a good idea to discuss your situation with a range of professionals including: your GP; a genetic counsellor/clinical geneticist; a psychologist; a breast surgeon and a clinical nurse specialist; as well as with close family members and friends. It’s important to give yourself plenty of time to weigh up the potential benefits and disadvantages before making a decision.

Remember, none of these discussions will commit you to a decision – they can simply help you to make your mind up.


Back to Risk-reducing breast surgery

What is risk-reducing breast surgery?

If you have a high risk of developing breast cancer, surgery to remove one or both breasts may lower your risk.

Options for women with a high risk of developing breast cancer

There are several options for women with a high risk of developing breast cancer.

How should I prepare for risk-reducing breast surgery?

You will meet with a team of healthcare professionals before you have risk-reducing surgery.

Having risk-reducing breast surgery

You and your breast surgeon will decide which type of risk-reducing breast surgery is suitable for you.

What happens after surgery?

Recovery can take some time after risk-reducing breast surgery. It will depend on the type of surgery you have had.

Possible problems following surgery

It’s a good idea to know the signs of common problems so you can be treated earlier.

Life after risk-reducing breast surgery

Risk-reducing breast surgery is a big step to take and it can cause many different emotions and feelings.