What is risk-reducing breast surgery?

Risk-reducing breast surgery is an operation that significantly reduces the risk of breast cancer developing. It does this by removing the healthy breast tissue from both breasts. It is also called a risk-reducing bilateral mastectomy.

Removing both breasts lowers the risk of getting breast cancer by about 95%. Although most of the breast tissue is removed, it is not possible to remove it all. This means a very small amount of tissue will be left. So there is still a small risk of breast cancer developing.

You can have breast reconstruction surgery at the same time as risk-reducing breast surgery. Breast reconstruction is surgery to make new breast shapes. Most people decide to have this, but some choose not to. New breast shapes can be made:

If you are considering having risk reducing breast surgery, you will be able to discuss your options for breast reconstruction surgery with a surgeon.

You can also download our table comparing breast reconstruction options [PDF, 33.8 KB] when having risk reducing surgery.

There are other options for managing high risk breast cancer. Some may be used instead of risk-reducing breast surgery. Or they may be used as well as the surgery.

Who might be offered risk-reducing breast surgery?

Risk-reducing breast surgery is only suitable for a small number of women, or people assigned female at birth, who have a high risk of getting breast cancer. You may be offered risk-reducing breast surgery if one or both of the following are true:

You may be offered risk-reducing breast surgery if you have:

Your doctor, a clinical geneticist or a genetic counsellor can talk to you about this.

Risk-reducing breast surgery may also be an option if you have had breast cancer and have a high risk of developing another breast cancer.

The timing of risk-reducing breast surgery

Whether to have risk-reducing breast surgery is your decision.

Risk-reducing breast surgery involves taking away healthy tissue rather than removing cancer. Whatever your situation, it is important you have time to think about your decision and when to have the operation.

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. Your genetics counsellor or breast surgeon can talk to you about your risk and and how it changes with age.

Types of risk-reducing breast surgery

You will have a pre-operative assessment before your operation. This will involve some tests to check your general health and fitness.

Your surgeon will talk to you about the different types of risk-reducing breast surgery and their risks and benefits. These are the main types of operation.

Skin-sparing mastectomy

This operation removes:

  • the nipples
  • the darker circles of skin around the nipples (areolas)
  • other tissue that makes up the breasts.

The surgeon will leave the skin that covers the breasts. This is used to cover your reconstructed breasts.

Nipple-sparing mastectomy

It may be possible to keep your nipples if you have risk-reducing breast surgery. This is usually if you are having breast reconstruction surgery at the same time as the mastectomy. This called having an immediate reconstruction.

A nipple-sparing mastectomy removes almost all the breast tissue but leaves the:

  • nipple
  • areola
  • breast skin.

These will be used to cover the reconstructed breasts. The nipple is then removed and reattached to the reconstructed breast. This can be done either with or without the areola. Or you can have a nipple reconstruction. This is where the nipple shape is made from the remaining skin and attached to the reconstructed breast.

If you are having a nipple-sparing breast reconstruction with implants, it can sometimes be difficult to achieve an ideal nipple position. The nipples may be too low. There can also be a slight increase in wound-healing problems if some breast skin is removed at the same time.

You can have further surgery to correct the nipple position. If you have naturally larger breasts, the surgeon may recommend surgery to lift your breasts before a mastectomy. This means some skin can be removed and the position of the nipple changed to a more natural position before the nipple-sparing mastectomy.

This operation helps make sure the nipple is in the right position when you have your operation to remove and reconstruct the breasts.

Simple mastectomy

This operation is done if you choose not to have breast reconstruction. The surgeon removes:

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

The skin that remains is used to cover the chest.

Goldilocks mastectomy

Like a simple mastectomy, this operation involves removing the breast tissue. But the surgeon uses the skin and fat, usually removed during a mastectomy, to form a small breast shape.

For some, it may look better than a simple mastectomy. It can also help to keep a breast prosthesis in position within a bra. A breast prosthesis is an artificial breast form that can be used to replace all or part of the breast.

Goldilocks mastectomy is not suitable for everyone. It will depend on the size of your breasts before surgery.

Types of breast reconstruction

If you have breast reconstruction, there are different types. The new breast shape can be made using a breast implant, or tissue taken from another part of your body, also known as flap reconstruction. A combination of both these types is sometimes used.

Preparing for breast surgery

You will have a pre-operative assessment before your operation. This will involve having some tests to check your general health and fitness.

You may be given information about what to bring into hospital, such as:

  • comfortable clothes and nightwear with buttons down the front
  • a supportive bra.

If you smoke, your surgeon will talk to you about giving up smoking before surgery. If you have breast reconstruction, you are more likely to develop problems after breast reconstruction surgery if you smoke. Your hospital and GP will give you help and support to stop smoking.

After breast reconstructive surgery

Your breast care nurse will give you advice and support on what to expect after breast reconstruction. If it is needed, the ward nurses can arrange for district nurses to visit you at home and look at any wounds and dressings .

You may have other operations or procedures you such as, having a nipple reconstruction or a procedure called lipomodelling (fat transfer). This may be used to smooth out any uneven areas of the new breast shape.

Checking your breast

You will not need to have any further screening tests after risk-reducing breast surgery. But you should still check your breast area regularly. There will be a small amount of breast tissue remaining.

Your feelings after risk-reducing breast surgery

Risk-reducing breast surgery can cause many different emotions and feelings. You may feel a sense of relief when the surgery is over. But it can still take time to get used to your new look. It is normal to have some concerns about how you see and feel about your body. If these do not improve, talk to your breast care nurse.

You have had a lot to cope with already. You may be dealing with the news that your family has a strong history of breast cancer and the impact this might have on you and your family. If you have children, you may worry about whether they will be affected in the future.

Some people say that risk-reducing breast surgery has reduced their anxiety about getting breast cancer. And many recommend surgery to others in a similar situation. But they may still have feelings of loss for their previous appearance and sense of health.

Your breast care nurse can talk over your situation with you. There are also people and organisations, such as Breast Cancer Now that can help you talk about and deal with your feelings and emotions.

You can also contact the Macmillan Buddies, or visit our breast cancer forum to talk with people who have been affected by breast cancer, share your experience, and ask an expert your questions.

Your sex life after risk-reducing surgery

Having breast surgery may affect your sex life and the way you think and feel about your body (body image).

Breast reconstruction creates new breast shapes. But the sensations in the breasts and nipples will not be the same as before.

If you have a partner, there may be a period of adjustment for you both. Talking to each other and sharing your feelings and fears can help you overcome most worries with time.

If you are having sexual difficulties that are not improving, help is available. You can get sex counselling through Relate or the College of Sexual and Relationship Therapists (COSRT). Or ask your doctor to refer you to a sex counsellor.

We have more information about recovering after breast reconstruction surgery.

About our information

  • References

    Below is a sample of the sources used in our risk-reducing breast surgery information. If you would like more information about the sources we use, please contact us at cancerinformationteam@macmillan.org.uk

    National Institute for Health and Clinical excellence, Clinical guideline CG164, published 25 June 2013, last updated 20 November 2019: Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer. www.nice.org.uk/guidance/cg164 (accessed April 2023) 

    Paluch-Shimon. S, Cardoso. F, Sessa. C, Balmana. J, Cardoso. M, Gilbert. F, Senkus. E, on behalf of the ESMO Guidelines Committee (2016): Prevention and screening in BRCA mutation carriers and other breast/ovarian hereditary cancer syndromes: ESMO Clinical Practice Guidelines for cancer prevention and screening. Annals of Oncology 27 (Supplement 5): v103–v110, 2016 doi:10.1093/annonc/mdw327 www.annalsofoncology.org/article/S0923-7534(19)31645-X/fulltext (accessed April 2023)      

  • Reviewers

    This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer. It has been approved by Senior Medical Editor, Professor Mike Dixon, Professor of Surgery and Consultant Breast Surgeon.

    Our cancer information has been awarded the PIF TICK. Created by the Patient Information Forum, this quality mark shows we meet PIF’s 10 criteria for trustworthy health information.

The language we use

We want everyone affected by cancer to feel our information is written for them.

We want our information to be as clear as possible. To do this, we try to:

  • use plain English
  • explain medical words
  • use short sentences
  • use illustrations to explain text
  • structure the information clearly
  • make sure important points are clear.

We use gender-inclusive language and talk to our readers as ‘you’ so that everyone feels included. Where clinically necessary we use the terms ‘men’ and ‘women’ or ‘male’ and ‘female’. For example, we do so when talking about parts of the body or mentioning statistics or research about who is affected.

You can read more about how we produce our information here.

Date reviewed

Reviewed: 01 November 2022
Next review: 01 November 2025
Trusted Information Creator - Patient Information Forum
Trusted Information Creator - Patient Information Forum

Our cancer information meets the PIF TICK quality mark.

This means it is easy to use, up-to-date and based on the latest evidence. Learn more about how we produce our information.