The Role of Surgery in Breast Cancer Prevention

Breast cancer affects women in every corner of the globe. Although it is much more prevalent in women, men also can develop breast cancer because their bodies contain some breast tissue where the cancer takes root.

The World Health Organization says breast cancer was the most common cancer in women in 157 countries out of 185 in 2022. Roughly half of all breast cancers occur in women with no specific risk factors other than sex and age. As a result, the approach to breast cancer often is reactive rather than proactive. However, for individuals with an elevated risk of breast cancer, namely a family history of breast cancer or an inherited genetic link, surgery might be considered as a proactive measure.

Surgery to reduce breast cancer risk goes by different names. Macmillan Cancer Support in the United Kingdom calls it riskreducing breast surgery. Other organizations, like the Cleveland Clinic, call it a prophylactic mastectomy, and the Mayo Clinic refers to it as a preventative mastectomy. No matter the name, the outcome is the same. A prophylactic (preventative) mastectomy is a surgery to remove one or both breasts, says the Cleveland Clinic. This type of surgery may be recommended by health care providers for individuals with high risk of developing breast cancer, such as those who have a BRCA1 or BRCA2 gene mutation. Macmillan Cancer Support says this preventative surgery can lower the risk of getting breast cancer by roughly 95 percent for those who undergo bilateral mastectomy. It is not possible to remove all breast tissue, which is why there is still a small chance that breast cancer can develop even after surgery.

There are different types of preventative mastectomy surgeries. The bilateral (double) is the most extensive in that both breasts are removed. A contralateral mastectomy removes the healthy breast in people who have cancer in the other breast. A skinsparing mastectomy removes the areola and nipple, then removes breast tissue through that small incision. A nipplesparing mastectomy removes only the breast tissue without affecting the nipple or areola. Finally, a double mastectomy with reconstruction removes both breasts and then reconstructs them using tissue from elsewhere in the body or implants.

Brigham and Women’s Hospital says health care experts can discuss the pros and cons of prophylactic surgery for those who are at high risk. Women who choose to proceed with the surgery will find oncologists typically work in conjunction with plastic surgeons to help patients achieve the best results with as few procedures as possible.

Typically, those who have undergone preventative mastectomy will not need further screening tests for breast cancer. However, it is still advisable to check the breast area regularly for any abnormalities due to the small amount of breast tissue that remains. The Cleveland Clinic says recovery time varies after the procedure, but it can be three to four weeks on average, or up to eight weeks if a breast reconstruction also has occurred. It may take several months before individuals can resume normal activities.

Preventative surgery is an option for those who have very high risk for breast cancer and want to reduce their risk of developing the disease.