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.

After having risk-reducing surgery, many women say 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 counsellor, psychologist, breast surgeon and clinical nurse specialist, can discuss the benefits and disadvantages of surgery with you. They can explain the different types of surgery and 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.

Deciding about risk-reducing breast surgery

Whether to have risk-reducing breast surgery is your decision. You may need lots of time to make up your mind. Or you may already have decided that surgery is right for you.

The surgery involves removing healthy tissue rather than removing cancer. So whatever your situation, it’s important that you have time to carefully consider things.

You will usually have several appointments with different healthcare professionals. They will talk to you about:

  • your risk of breast cancer
  • the different options for managing or reducing your risk what risk-reducing breast surgery involves
  • your options for breast reconstruction
  • your feelings about the surgery and how it may affect you and your relationships.

This usually takes a few months, which may sound like a long time. But it’s important to take time to make sure you make an informed decision.

The following healthcare professionals will support you while you make your decision:

  • A clinical geneticist or genetics counsellor will explain your risk of getting breast cancer. They will explain your risk over your lifetime and over the next 5–10 years. They will also talk to you about your options for reducing or managing your risk of breast cancer.
  • A breast surgeon will talk to you about your risk of breast cancer and about risk-reducing breast surgery.
  • A reconstructive surgeon will discuss breast reconstruction options with you. They can show you photos of women who have had risk-reducing breast surgery and breast reconstruction.
  • A breast care nurse will give you information and support.
  • A psychologist can help you explore your feelings and expectations about risk-reducing breast surgery. They can help you think about what support you may need to cope with the effects of surgery and a change in your body image.

Everyone’s different – it’s not something that’s right for everyone. Some people want to do it. But you’ve got to do what you’ve got to do, for yourself.

Karin


Making your decision

Some women find it helps to take notes at their appointments. This can help you to remember what has been said.

It may also help to write down what you see as the advantages and disadvantages of having surgery.

There are possible advantages and disadvantages of having risk-reducing breast surgery:

Advantages of risk-reducing breast surgery

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

Disadvantages of risk-reducing breast surgery

  • It can take up to six months or more to fully recover after the operation.
  • 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.
  • Even if you don’t have the operation, you may not develop breast cancer anyway.
  • 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.


Your feelings – things to consider

You will need time to explore your feelings about having your breasts removed. This is important even if you have already decided you want to have risk-reducing breast surgery. You may have strong emotions after the operation. Taking time to think through how you feel can help you prepare.

If you are in a relationship, talking openly with your partner can help prevent misunderstandings. It helps to share your feelings and any worries or concerns with each other. This will mean you don’t need to try to guess what your partner may be thinking or feeling. If you can, find ways of talking about things. This will help you communicate openly after surgery, if you decide to have it. If you and your partner find talking things over together is difficult, ask your breast care nurse, counsellor or psychologist for advice.

People may react in different ways when you tell them you are thinking about risk-reducing breast surgery. Some people may have strong opinions about the surgery, which might be different from your own. This can be difficult to deal with. It’s important that you have support to help you focus on what’s important to you. A psychologist or a breast care nurse can help you do this.

You may want to consider the following things:

  • What do your breasts mean to you?
  • How would having your breasts removed affect the way you feel about yourself sexually?
  • If you have a partner, do you know each other’s feelings and concerns about the surgery?
  • If you’re not in a long-term relationship, have you thought about how the surgery may affect future relationships?
  • How could the surgery affect your confidence?
  • Are other people in your life affecting your decision?
  • If you have an experience of cancer in your family, how is it affecting your decision?
  • How anxious do you feel about the possibility of getting breast cancer?
  • If you are thinking about having a reconstruction, have you thought about what your breasts will look and feel like afterwards?
  • What are your feelings about other options instead of surgery?


Talking to women who have had risk-reducing breast surgery

It can be helpful to hear about the experiences of other women who have been in a similar situation to you. Your surgeon or breast care nurse can arrange for you to talk to women who have had the surgery. 

You can also visit our online community at macmillan.org.uk/community to talk to women in similar situations.

But remember that everyone is different. What was right for one woman may not be right for you. Take as much time as you need to make your decision.


Types of risk-reducing breast surgery

Your surgeon will talk to you about the different risk-reducing breast operations, and their risks and benefits.

A skin-sparing mastectomy is the most common operation. The surgeon removes the nipples, the areolas (the darker circles of skin around nipples) and other tissue that makes up the breasts. But they don’t remove the skin that covers the breasts. This is used to cover your reconstructed breasts.

Some women have an operation to preserve the nipples as well as the skin covering the breasts. This is called a nipple-sparing (subcutaneous) mastectomy. It means the surgeon leaves some more breast tissue behind, but only a very small amount.

The surgeon takes away almost all the breast tissue under the nipples. Most surgeons think this kind of operation is safe, because there is very little risk of cancer developing in any tissue left under the nipple.

Women who choose not to have breast reconstruction usually have a simple mastectomy, where the surgeon removes:

  • the nipples
  • the areolas
  • the breast tissue
  • about half of the skin covering the breasts.

We have information about recovery after risk-reducing breast surgery.


Talking with your surgeon

It can often help to make a list of questions to ask your breast reconstructive surgeon. We have more information on talking to your surgeon before breast reconstruction.


The timing of risk-reducing breast surgery

If you decide to have risk-reducing breast surgery, you will need to think about when to have the operation.

Breast cancers in women who have breast cancer gene mutations usually happen at a younger age. If you have family members who had breast cancer, the ages when they developed breast cancer may also affect your decision.

In general, the younger you are when you have risk-reducing breast surgery, the more likely it is to prevent breast cancer. Your genetic counsellor or breast surgeon can advise you about how your risk level changes with age.

There are other things that can affect the timing of risk-reducing breast surgery. These may include whether you are in a relationship and your plans for having children and breastfeeding.

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