Risk-Reducing Surgery (Preventive Surgery)
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- Erica’s Story: I’m Unique and My Preventive Mastectomy Reflects Who I Am
- Three Generations Affected by Breast Cancer
Risk-reducing bilateral mastectomy
A risk-reducing bilateral mastectomy (bilateral prophylactic mastectomy) is the removal of both breasts to prevent breast cancer.
A risk-reducing bilateral mastectomy lowers the risk of breast cancer in women at high risk by at least 90% [39,234-236]. However, it doesn’t completely protect a woman from breast cancer [234-236].
A mastectomy isn’t able to remove all the breast tissue. This means there’s always a small chance breast cancer could occur in the remaining tissue.
Who may want to consider a risk-reducing bilateral mastectomy?
Women with a very high risk of breast cancer due to a mutation in one of these genes may consider a risk-reducing bilateral mastectomy to lower their risk of breast cancer [39]:
- BRCA1
- BRCA2
- CDH1
- PALB2
- PTEN
- STK11
- TP53
Women may choose a risk-reducing mastectomy to ease worries about getting breast cancer. It may also make them feel they’ve done all they can to lower their risk of breast cancer.
Pros and cons of a risk-reducing bilateral mastectomy
If you’re at high risk for breast cancer, talk with your health care provider about the pros and cons of a risk-reducing mastectomy. You may also want to discuss your breast reconstruction options with a plastic surgeon.
The benefits of a risk-reducing mastectomy seem to be greater in younger women than in older women. This is because younger women have more years of life ahead. For example, for a 30-year-old woman who has a BRCA1 or BRCA2 inherited gene mutation, a risk-reducing mastectomy may add 3-5 years to her lifespan [237-238]. For women 60 years and older, the gain in lifespan after a risk-reducing bilateral mastectomy is small [39,236-238].
In addition to the emotional impact of losing both breasts, a risk-reducing mastectomy may affect how you feel sexually [376-378]. Talking with a health care provider or counselor may help address these issues. It may also help to join a support group.
It’s also important to talk with your spouse or partner. Though they may be a main source of support for you during this time, they can also have an emotional response to the surgery.
There are also surgical risks from a risk-reducing mastectomy, including infection.
Learn more about a mastectomy and what to expect after surgery.
Learn more about sexuality and intimacy after breast surgery.
Breast reconstruction
If you choose to have a risk-reducing mastectomy, you may wish to have breast reconstruction. This may be done at the same time as the mastectomy or at a later time.
Talk with a plastic surgeon about your reconstruction options.
Insurance coverage
No federal laws require insurance companies to cover a risk-reducing mastectomy.
Some state laws require coverage for a risk-reducing mastectomy, but coverage varies state to state.
It’s best to check with your insurance company to learn about your plan’s coverage.
Learn more about health insurance.
Risk-reducing contralateral mastectomy
A risk-reducing contralateral mastectomy (contralateral prophylactic mastectomy) is the removal of the opposite (contralateral) breast in a person who has breast cancer in only one breast. It’s usually done at the same time as breast cancer surgery, so both breasts are removed during surgery.
Learn more about a risk-reducing contralateral mastectomy.
Risk-reducing salpingo-oophorectomy
Some inherited gene mutations increase the risk of both breast and ovarian cancers.
A risk-reducing bilateral salpingo-oophorectomy (prophylactic bilateral salpingo-oophorectomy) is the surgical removal of the fallopian tubes and the ovaries to prevent ovarian cancer. It can lower the risk of ovarian cancer by 70% to over 90% [39,237,239-243].
The National Comprehensive Cancer Network (NCCN) recommends women with a family history of ovarian cancer likely due to an inherited gene mutation have (or consider having) a risk-reducing bilateral salpingo-oophorectomy [39]. This includes women with an inherited mutation in one of these genes [39]:
- BRCA1
- BRCA2
- PALB2
- RAD51C
- RAD51D
The age a risk-reducing bilateral salpingo-oophorectomy is recommended varies by gene mutation [39].
Risk-reducing salpingo-oophorectomy in women with a BRCA1 or BRCA2 inherited gene mutation
The NCCN recommends women with a BRCA1 or BRCA2 inherited gene mutation have a risk-reducing bilateral salpingo-oophorectomy between ages 35-40 (or after childbearing is complete) to lower the risk of ovarian cancer [39].
Women with a BRCA2 gene mutation tend to be diagnosed with ovarian cancer at a later age than women with a BRCA1 gene mutation [39]. So, women with a BRCA2 mutation may delay having a risk-reducing bilateral salpingo-oophorectomy until ages 40-45 [39].
However, if a family member was diagnosed with ovarian cancer at a young age, a risk-reducing bilateral salpingo-oophorectomy for women with a BRCA2 gene mutation may be recommended earlier [39].
Risk-reducing salpingo-oophorectomy in women with other inherited gene mutations that increase breast and ovarian cancer risk
The NCCN recommends [39]:
- Women with a RAD51C or RAD51D inherited gene mutation have a risk-reducing bilateral salpingo-oophorectomy starting at age 45-50
- Women with a PALB2 inherited gene mutation consider having a risk-reducing bilateral salpingo-oophorectomy starting at age 45-50
Risk-reducing salpingo-oophorectomy and breast cancer risk
A risk-reducing bilateral salpingo-oophorectomy may also lower the risk of breast cancer in some women [39,212,244].
Risk-reducing salpingo-oophorectomy and hysterectomy
Some data suggest women with a BRCA1 inherited gene mutation may have a slightly increased risk of uterine cancer (serous type) [39]. This topic is under study.
However, if you have a BRCA1 gene mutation and are having a risk-reducing bilateral salpingo-oophorectomy, talk with your health care provider about the risks and benefits of having a hysterectomy (surgical removal of the uterus) at the same time [39].
Risk-reducing salpingo-oophorectomy and menopause
By removing the ovaries, an oophorectomy stops the production of estrogen and progesterone. If you are premenopausal, this will permanently end your menstrual periods and lead to early menopause.
Learn more about early menopause and how to manage its symptoms.
Support
Some support groups are tailored to people with BRCA1 or BRCA2 (BRCA1/2) inherited gene mutations and those with BRCA1/2-related breast cancers.
Our Support section offers a list of resources to help you find local and online support groups. For example, FORCE provides virtual support groups, telephone support and a resource guide for individuals and caregivers affected by hereditary breast, ovarian and other cancers.
Sharsheret offers virtual programs and peer support for Jewish women affected by hereditary breast and/or ovarian cancer.
Susan G. Komen® Support Resources |
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Insurance issues and financial assistance
If you have insurance issues (such as a claim is denied) or need help paying for genetic testing, risk-reducing drugs or other out-of-pocket expenses, there are resources that may help.
Learn about insurance and financial assistance programs.
Komen Financial Assistance Program |
Susan G. Komen® created the Komen Financial Assistance Program to help those struggling with the costs of breast cancer treatment by providing financial assistance to eligible individuals. To learn more about this program and other helpful resources, call the Komen Patient Care Center at 1-877 GO KOMEN (1-877-465-6636) or email helpline@komen.org. Se habla español. |
* Please note, the information provided within Komen Perspectives articles is current as of the date of posting. Therefore, some information may be out of date.
Updated 12/19/24
This content is regularly reviewed by an expert panel including researchers, practicing clinicians and patient advocates.
