Mastectomy, or removal of the breast, may be performed as a therapeutic or preventive mode of treatment. Therapeutic mastectomy is done to treat breast ailments (benign or malignant). The procedure performed to reduce the consequent risk of developing malignancy by removing “normal” breasts is known as a “risk reduction” or “prophylactic” or “preventive” mastectomy.
Unlike the various types of mastectomy (radical, simple/total, skin-sparing and nipple-sparing/subcutaneous) which are based on the type of mastectomy surgical technique, these procedures are unique in the sense that depicts the reason for the mastectomy to be performed.
Risk Reduction Mastectomy (RRM)
Prophylactic or risk-reduction mastectomy is performed to prevent or minimize the risk of breast cancer in women who are at high risk of developing the disease. Usually, risk reduction mastectomy is followed by breast reconstruction.
What alternatives to surgery exist for preventing or reducing the risk of breast cancer in women at high risk?
Routine breast examination by the doctor and advanced imaging modalities such as mammography and breast MRI are considered various alternatives to surgery in screening and preventing breast cancer at its early stage. Certain medications are proven to reduce the possibilities of getting breast cancer in women at high risk for the disease. These measures aim at early detection of breast cancer.
How effective is risk reduction mastectomy in preventing or reducing the risk of breast cancer?
Recent survey indicates that risk reduction mastectomy significantly reduces the chance of developing breast cancer in moderate and high-risk women. This reduces the risk in women with an elevated risk down to a level well below that of an average woman.
Why would a woman consider undergoing bilateral prophylactic mastectomy (BPM)?
Bilateral prophylactic mastectomy (BPM) is a procedure done to decrease the risk of breast cancer in women at high risk of breast cancer. The following factors contribute to the potential risk of developing breast cancer in a woman:
- Positive genetic test results for mutations of BRCA1 and BRCA2 indicate higher risk of breast cancer in a woman.
- Strong family history of breast cancer is a factor.
- Lobular carcinoma in situ (LCIS) is considered a risk factor for development of breast cancer.
- History of previous radiation therapy to the chest (including the breasts) before age 35 poses an increased risk of developing breast cancer.
The final cosmetic outcome and post-operative morbidity are the two major factors considered when a woman decides to undergo risk reduction mastectomy.
Contralateral Prophylactic Mastectomy (CPM):
Contralateral Prophylactic Mastectomy (CPM) is the surgical removal of a non-affected breast in a woman with unilateral breast cancer.
- To reduce contralateral breast cancer risk in high-risk patients.
- For patients in whom surveillance with mammograms or ultrasound is difficult because of dense breast tissue or diffuse indeterminate calcifications.
- To improve symmetry in patients undergoing reconstruction for tumour or to maintain balance in women undergoing unilateral mastectomy.
The increase in the CPM rate is especially concerning among women with early-stage breast cancer who have a minimal risk for developing contralateral breast cancer. Treatment factors, such as immediate reconstruction, preoperative MRI, and unsuccessful attempts at breast conservation, possibly are associated with increased rates of CPM.
At the time of diagnosis, many breast cancer patients lack the knowledge and information needed to make informed decisions about treatment. The physicians communicate with patients regarding treatment options and ensure that the associated risks and complications are discussed before the surgery.