Every year, breast cancer makes up about 1 in 3 new cancer diagnoses among women in the United States, not including skin cancer. People at high risk of developing breast cancer may choose a prophylactic mastectomy to reduce their cancer risk.

Mastectomy — surgical removal of breast tissue — is often used in breast cancer treatment. The procedure may also be performed to help reduce the risk of breast cancer in certain people. In these cases, it’s called a prophylactic mastectomy.

Prophylactic mastectomy is one way to lower the risk of breast cancer. But for some people, other strategies may be a better fit, including enhanced screening, medications to lower risk, and lifestyle changes.

Your healthcare providers can help you decide whether prophylactic mastectomy is right for your situation. Here are six facts to know about prophylactic mastectomy.

Key Facts About Prophylactic Mastectomy

Prophylactic mastectomy, also called risk-reducing mastectomy or preventive mastectomy, can be an effective way to reduce breast cancer risk for some people at high risk. But the procedure isn’t the best choice for everyone. There are some important considerations to keep in mind.

Before making a decision, carefully weigh the benefits and risks of the surgery with your healthcare team.

Mastectomy is a major surgery often performed on people who are living with breast cancer. During mastectomy surgery, a surgeon removes breast tissue that contains cancer cells. This can help treat cancer in the breast and lower the risk that cancer will come back in that area.

Prophylactic mastectomy helps lower the chance of breast cancer developing in people who are at a higher risk due to family history, inherited gene mutations (changes), or other factors. This type of surgery removes breast tissue that could become cancerous in the future.

“My nephew’s girlfriend had a prophylactic mastectomy done last year. She is young, healthy, and the surgery was relatively easy on her. She is very happy with the results as well as the comfort it brought her by taking away her fears.”

— A MyBCTeam member

Whether prophylactic surgery can help reduce your odds of developing breast cancer depends on your overall level of risk.

For instance, a prophylactic mastectomy may reduce breast cancer risk by 90 percent for people who have a strong family history and by 95 percent for people with BRCA1 or BRCA2 gene mutations. However, it does not remove all risk because some breast tissue may remain after surgery.

Prophylactic mastectomy isn’t recommended for breast cancer prevention in people at average risk. It’s usually considered for people with a much higher risk of developing breast cancer.

A lifetime risk of breast cancer that’s lower than 15 percent is considered average, while 20 percent or higher is often considered high risk.

Certain risk factors can increase your risk of developing breast cancer, including:

• A very strong family history of breast cancer — For example, having two or more immediate family members who have had breast cancer, particularly those diagnosed before age 50
• Inherited gene mutations — Positive genetic tests for mutations linked to higher breast cancer risk, such as BRCA1, BRCA2, PALB2, PTEN, TP53, or CDH1
• Certain breast conditions — Being diagnosed with lobular carcinoma in situ, atypical ductal hyperplasia, or atypical lobular hyperplasia, which are conditions involving abnormal breast cells that may raise breast cancer risk
• Certain breast characteristics — Having dense breast tissue, widely spread breast microcalcifications (tiny calcium deposits in breast tissue), or other breast changes that make it harder to use imaging to monitor for cancer
• Radiation exposure — Having a history of radiation therapy to the chest, especially between the ages of 10 and 30

One member of MyBCTeam shared that their mother had a prophylactic mastectomy in her early 40s. “Her mom had breast cancer, and she had two sisters that eventually passed away (out of five girls in the family),” the member wrote. “She fought to get the surgery done when most people were still not recognizing it as a necessity (this was in the 80s). She never got cancer. I did.”

Some risk factors increase your risk of developing breast cancer more than others. Your healthcare provider can help you understand your level of risk and whether it makes sense to consider preventive surgery.

Prophylactic mastectomy isn’t the only way to manage breast cancer risk. Other options, such as close monitoring, medications, and lifestyle changes, can also help monitor or lower risk in some people.

Regular Screening

Mammograms are breast imaging tests used to screen for breast cancer. They don’t prevent cancer, but they can help find it early, when it may be easier to treat. This monitoring strategy may be right for people at average risk of developing breast cancer and for some people at higher risk who want to avoid or delay surgery.

Risk-Reducing Medication

Risk-reducing medications can help lower your chances of developing some types of breast cancer. These drugs are usually recommended for people who have a high risk of breast cancer. Your doctor may suggest combining medications with other risk-reduction strategies.

Lifestyle Changes

Lifestyle strategies are often recommended for many people as a way to reduce breast cancer risk. These include:

• Limiting alcohol intake
• Exercising regularly
• Eating a balanced diet

Talk to your doctor about your risk level. They can recommend the best ways to monitor your breast health and lower your breast cancer risk.

Prophylactic mastectomy doesn’t refer to just one type of surgery. If you’re considering a preventive mastectomy, your doctor can help you decide which surgery is right for you.

Prophylactic mastectomies may be performed on one or both breasts. A bilateral mastectomy, or double mastectomy, means both breasts are removed. Some people who have cancer in one breast may choose to remove the other breast. This is called a contralateral prophylactic mastectomy.

People having a double mastectomy may choose breast reconstruction (rebuilding of the breasts) using their own tissue or an implant.

Surgery complications may occur with mastectomy, including infection, bleeding, or loss of feeling. Talk to your healthcare team about the specific level of risk associated with each type of surgery.

Prophylactic mastectomy alone usually takes about two to three hours to perform. If you’re having breast reconstruction, your surgery will take longer. You might need to stay overnight at the hospital after the procedure.

Recovery times can vary depending on the type of surgery. Your healthcare team will give you exercises to help reduce stiffness, improve shoulder and arm movement, and reduce how much scar tissue forms.

"I was holding my breath, hoping to get through having kids before getting a prophylactic mastectomy, but my luck didn't hold.”

— A MyBCTeam member

Overall, recovery after mastectomy usually takes three to four weeks, while recovery from surgery with breast reconstruction can take up to two months.

Prophylactic mastectomy changes your body. How your breasts look and feel after surgery may be very different from what you’re used to. It can affect your ability to breastfeed, bring up concerns about body image, or affect your sexual satisfaction.

After a prophylactic mastectomy, a person won’t be able to breastfeed from the breast or breasts that were removed. A member of MyBCTeam tried to wait to have a prophylactic mastectomy until after they had children. “I was holding my breath, hoping to get through having kids before getting a prophylactic mastectomy, but my luck didn't hold,” the member wrote.

Prophylactic mastectomy causes major changes to the breasts that can affect mental and emotional well-being. This can lead to feelings of anxiety or depression for some people.

Many people report feeling self-conscious about how their breasts look or how their surgical scars look.

A mastectomy can reduce feeling in your breasts, which may affect sexual satisfaction, confidence, and mental health.

One study found that 36 percent of women had ongoing concerns about body image 14 years after their bilateral mastectomies.

For some people, breast reconstruction might help them feel more comfortable and confident. Others may choose not to have reconstruction and may still feel comfortable with their decision. It’s important to talk to your doctor about your concerns so you can work together on a plan that’s best for you.

Despite the emotional effects, many people who have prophylactic mastectomies say they are glad they did. Studies report that between 70 percent and 90 percent of people who had risk-reducing mastectomies were satisfied with their decision 10 to 20 years later.

A MyBCTeam member shared that their nephew’s girlfriend underwent a prophylactic mastectomy. “She is young, healthy, and the surgery was relatively easy on her,” the member wrote. “She is very happy with the results as well as the comfort it brought her by taking away her fears.”

Talk to Your Doctor

Whether to get a prophylactic mastectomy is a highly individual decision. A healthcare team that includes an oncologist (a doctor who specializes in cancer), genetic counselor, breast surgeon, and mental health professional can help you weigh the benefits and risks of surgery.

Breast cancer can’t always be prevented. Some risk factors, such as inherited gene mutations or family history, are outside your control. Discuss your unique risk factors, your values, and your concerns with your healthcare team so you can work together to decide what’s right for you.

Join the Conversation

On MyBCTeam, people share their experiences with breast cancer, get advice, and find support from others who understand.

Did you or someone you know have a preventive mastectomy? Let others know in the comments below.