Prophylactic mastectomy
Today we cannot know for certainty which of the patients with precancerous breast diseases with a breast cancer risk, will develop the disease itself!
Prophylactic mastectomy is a surgical option for people with the increased risk of breast cancer.
It is well known that prophylactic mastectomy can reduce breast cancer risk by 90-95% in patients with increased risk of the disease. Therefore, prophylactic mastectomy does not ensure the complete removal of the glandular tissue and does not guarantee 100% discouragement of this condition throughout the life.
The criteria for admission of patients for prophylactic mastectomy surgery are:
- Positive BRCA1 and BRCA2 genetic tests;
- Family history of aggravated breast cancer;
- Breast cancer at one of the breasts;
- Presence of lobular carcinoma in situ;
- Chest radiotherapy up to 30 years;
- A mastopathy without effect after a conservative treatment and repeated sectoral resections;
- High density of breasts or the breasts with diffuse microcalcines.
The decision in favor of prophylactic mastectomy and simultaneous breast reconstruction can be taken by the mammologist surgeon and the plastic surgeon only after the attentive examination of the risk factors present at the patient and only with the complete agreement of the patient.
Prophylactic mastectomy surgery
The surgery of prophylactic mastectomy is performed under a general anesthesia. The access option – for each case – is individual and it is established according to the presence and area of the scars after the previous sectoral mammary resections. In this operation, the lymphatic reflux from the armpit is not affected, so it does not follow the lymphatic stasis of the extremity, and the recovery is faster. Breast reconstruction is most commonly performed with the application of the breast implants.
If the breast cancer that has affected one of the breasts and the other is apparently healthy, contralateral prophylactic mastectomy (in the healthy breast) can also be performed. Breast reconstruction can be performed in the same operation as the prophylactic mastectomy. The operation also includes the risks of anesthesia, bleeding, infection, asymmetries, anxiety and others.
Alternative methods
No method of conservative treatment ensures the prevention of breast cancer and does not prevent the passage of precancerous conditions into cancer!
There are the following alternative options for breast cancer prophylaxis at patients with the increased risk:
- Estrogen blocking medication (tamoxifen, raloxifene) can reduce the risk by about 50%;
- Surgical removal of the ovaries reduces estrogen levels and the risk of breast cancer by 50%;
- A certain role of breast cancer prophylaxis may have the correct lifestyle, body weight, diet, smoking avoidance, etc.
Only prophylactic mastectomy can ensure breast cancer prophylaxis at 90-95% of the patients!