For women at high risk of breast cancer, a prophylactic mastectomy—also known as a preventative or risk-reducing mastectomy—can be a life-changing decision. The surgery removes as much of the breast tissue as possible to significantly lower the chance of developing breast cancer, particularly in individuals with a BRCA1, BRCA2, or certain other genetic mutations. Studies show that undergoing a prophylactic mastectomy can reduce breast cancer risk by up to 95%.

While a prophylactic mastectomy offers substantial protection, Dr. Tyler Merceron points out that it’s not a guaranteed solution: “Some breast tissue remains even after surgery, so there is still a small chance of cancer developing. However, for high-risk patients, this surgery is often a proactive step toward greater peace of mind.”

Should I consider surgery to lower my risk of breast cancer?

A prophylactic mastectomy is typically recommended for individuals with a significantly elevated risk of developing breast cancer. You may be a candidate if you:

• Have tested positive for BRCA1, BRCA2, or other specific genetic mutations (e.g. TP53, ATM, PALB2, CHECK2, CDH1)
• Have a strong family history of breast cancer, especially in close relatives
• Have previously had radiation therapy to the chest before the age of 30
• Have a personal history of lobular carcinoma in situ (LCIS)
• Have dense or atypical breast tissue that increases cancer risk

Every patient’s risk factors and medical history are unique, so it’s essential to consult with a qualified breast surgeon and a plastic reconstructive specialist, like those at PRMA, to explore all available options.

What is Prophylactic Mastectomy?

A prophylactic mastectomy, or preventative breast cancer surgery, is performed to remove the majority of the breast tissue before cancer develops. In many cases, the procedure is done using a nipple-sparing approach, which preserves the nipple and all the breast skin for a more natural reconstruction outcome. For patients considering breast reconstruction, mastectomy and reconstruction can often be performed in a single surgery, providing both aesthetic and emotional benefits.

For women at very high risk of breast cancer

Women with a BRCA1 or BRCA2 mutation or a strong family history of breast cancer may choose to undergo a double mastectomy for breast cancer prevention. This proactive decision significantly reduces the likelihood of developing breast cancer and can provide long-term peace of mind. 

For women already diagnosed with breast cancer

In some cases, women diagnosed with cancer in one breast may opt for a contralateral prophylactic mastectomy, which involves removing the healthy breast as a preventative measure. This is often considered when there is a high risk of developing cancer in the other breast.

How does radiation therapy affect reconstruction?

• Radiation can impact reconstruction choices, timing and outcomes, and sometimes requires a staged approach.
• Patients needing radiation may benefit from delayed reconstruction, where initial surgery removes the breast tissue, and reconstruction is performed later.
• At PRMA, we tailor reconstruction decision-making based on your treatment plan to ensure the best aesthetic and functional results.

Is Prophylactic Mastectomy Guaranteed to Eliminate Breast Cancer Risk?

While a prophylactic mastectomy greatly reduces the likelihood of developing breast cancer, it does not eliminate the risk entirely. Tiny amounts of breast tissue can remain in areas such as the chest wall, collarbone, and armpits. Because of this, there is always a small chance that breast cancer could still develop.

That said, the procedure is highly effective for risk reduction and reduces the risk of developing breast cancer more than non-surgical measures, like enhanced screening (MRI, mammograms), lifestyle modifications, and chemoprevention (medications like tamoxifen or raloxifene).

Dr. Merceron points out the importance of follow-up care: “Women who undergo a prophylactic mastectomy should continue regular follow-ups with their healthcare team to monitor their overall breast health.”

Does breast reconstruction interfere with cancer treatment?

• No, breast reconstruction is planned alongside your cancer treatment to ensure optimal timing.
• Some patients may undergo immediate reconstruction (at the same time as the mastectomy), while others may have delayed reconstruction (as a separate surgery any time after the mastectomy), based on their medical needs.
• Your medical oncologist, breast surgeon and reconstructive surgeon will work together to determine the safest approach.

Understanding Your Options

Deciding to undergo a prophylactic mastectomy is deeply personal. It’s important to weigh the pros and cons of prophylactic mastectomy, discuss reconstruction options, and consider the emotional and physical impact. At PRMA, we believe every patient deserves individualized care, comprehensive education, and a supportive community to guide them through their journey. 

Take the Next Step: Consult With Your San Antonio Breast Specialists About Your Options

Many of our patients have worried about balancing cancer treatment with reconstruction. Sarah, a PRMA patient, shared: ‘I was afraid reconstruction would delay my treatment, but PRMA helped me find the right approach. My cancer care was never compromised, and I feel whole again.’

Choosing a prophylactic mastectomy is a major decision, and PRMA is here to help you every step of the way. Our San Antonio, Texas based team provides unparalleled surgical expertise and compassionate support to empower and inform you throughout your journey. With over 25 years of experience in breast reconstruction and a commitment to patient-centered care, PRMA is dedicated to helping you achieve the best possible outcome.

Considering breast reconstruction? PRMA’s microsurgeons work closely with your oncology team to develop the safest, most effective reconstruction plan. Schedule a free consultation today to explore your options.