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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. It is also called a risk-reducing mastectomy or bilateral mastectomy.
Removing both breasts reduces the risk of getting breast cancer by about 95%. Although almost all the breast tissue is removed, it is not possible to remove it all. A very small amount will remain, so there is still a small risk of developing breast cancer.
Breast reconstruction can be done at the same time as risk-reducing breast surgery. This is surgery to make new breast shapes. Most women have this, but some women choose not to.
Risk-reducing breast surgery is only appropriate for a small number of women with a high risk of getting breast cancer. A high risk means a 3 in 10 (30%) or greater chance of getting breast cancer in your lifetime.
You may be offered risk-reducing breast surgery if you have:
- a strong family history of breast cancer or ovarian cancer, or both.
- had a positive test for the gene mutations (changes) linked to an increased risk of breast cancer. These include BRCA1, BRCA2, TP53, PTEN and ATM.
Risk-reducing breast surgery involves removing healthy tissue rather than removing cancer. Whatever your situation, it is important that you have time to think about your decision.
A team of specialists will answer your questions and give you the information you need. You may need lots of time to decide or you may already have decided.
This usually takes a few months. This may sound like a long time. But it is important to take time to make sure you make an informed decision. These healthcare professionals will support you while you make your decision:
Clinical geneticist or genetics counsellor
They will explain what risk reducing surgery involves
They will talk about your options for breast reconstruction with you.
Breast care nurse
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.
Talking to women who have had risk-reducing breast surgery
It can be helpful to hear 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 also had risk-reducing breast surgery.
You can also visit our Online Community to talk to women who have had a similar experience.
Advantages and disadvantages of risk reducing surgery
Your healthcare team will talk over the advantages and disadvantages of having risk reducing surgery.
- The operation greatly reduces your risk of developing breast cancer.
- Afterwards most women say they feel much less anxious about getting breast cancer
- You will not need to have breast screening.
- Sometimes it can take up to 6 months or more to fully recover after the operation.
- As with all operations, there can be complications.
- Your body will not look the same as before and some women might be unhappy with the change in appearance
- Some women feel less confident sexually.
If you are having breast reconstruction, you usually need more than one operation to get the best cosmetic result.
You will need time to explore your feelings about having risk-reducing breast surgery. This is important even if you have already decided to have the operation. You may have some difficult feelings afterwards. Taking time to think about how you feel can help you prepare.
If you have a partner, talking over your feelings, worries or concerns with each other can help.. If you and your partner find it difficult to talk about how you feel speak to your breast care nurse, counsellor or psychologist for advice.
Some other people may react in different ways when you tell them you are thinking about having risk-reducing breast surgery. This can be difficult to deal with. But try to focus on what is important to you. A psychologist or a breast care nurse can help you to do this. Some of the things you may want to think about are:
- How you feel about your breasts and how having them removed could affect you and your confidence?
- How anxious do you feel about the possibility of getting breast cancer?
- If you have a partner, do you know each other’s feelings and concerns about the surgery?
- How do think the surgery may affect future relationships?
- Are other people in your life affecting your decision?
If you decide to have risk-reducing breast surgery, you will need to think about when to have the operation.
Women who have breast cancer gene mutations are more likely to develop breast cancer at a younger age. If you have family members who had breast cancer, the ages when they developed breast cancer may 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 talk to you about how your risk changes with age.
There are other things that can affect the timing of risk-reducing breast surgery. For example, this may include whether you are in a relationship, or have plans for having children and breastfeeding in the future.
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.
This operation removes almost all of the tissue that makes up the breasts. But the surgeon will leave the nipples and the skin covering the breasts in place. These will be used to cover the reconstructed breasts. The surgeon takes away all or almost all the breast tissue under the nipples.
There is no greater risk of cancer developing with a nipple-sparing mastectomy than with a skin-sparing mastectomy.
This operation is done if a woman chooses 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.
Your breast surgeon and specialist nurse will explain:
- the different types of operation and what is most suitable for you
- what the area will look like after surgery
- possible complications of the operation
- how long it will take you to recover.
The breast tissue that is removed during risk reducing surgery is always examined after the operation for any signs of cancer.
Many women are relieved when the surgery is over. They often say having risk-reducing breast surgery has reduced their anxiety about developing breast cancer. But they may still have feelings of loss about their previous appearance and their sense of health.
But it can take time to get used to your new appearance. It is normal to have some concerns about how you think and feel about your body. This is called body image. If these concerns do not improve, talk to your breast care nurse.
Having breast surgery may affect your sex life and your body image.
Breast reconstruction forms new breast shapes but the sensations will not be the same as before. If you have a partner, there will usually be a period of adjustment for you both. Talking to each other and sharing your feelings and fears can help you overcome most difficulties with time.
We have more information about your sex life after having breast reconstruction.