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Prophylactic Mastectomy: A Preventive Measure For Breast Cancer

Prophylactic mastectomy is becoming an increasingly popular way to reduce breast cancer risk.

Introduction

<a href="https://merisehat.pk/disease/breast-cancer">Breast cancer</a> is the most common cancer among women worldwide. It can be life-threatening, but early detection and treatment can increase the chances of survival.

However, prevention remains the most effective way to reduce the risk of developing breast cancer. The surgical removal of one or both breasts as part of a prophylactic mastectomy lowers the likelihood of getting breast cancer.

This article will discuss the concept of prophylactic mastectomy, its types, indications, and potential benefits and risks. 
&nbsp;

Understanding  Prophylactic Mastectomy for Breast Cancer prevention

Breast cancer is a common and recurring disease. Different methods, like early detection with imaging, chemoprevention, and surgery, can help prevent the condition. Prophylactic mastectomy is becoming an increasingly popular way to reduce breast cancer risk<a href="#accordion">[1]</a>.

One or both breasts are removed during a prophylactic mastectomy to lower the chance of getting breast cancer.

The surgery is recommended for women with a high risk of developing breast cancer due to their family history, genetic mutations, or a previous breast cancer diagnosis. 
&nbsp;

<ul>
	<li>Bilateral (Double) Mastectomy </li>
</ul>

Both breasts are removed in this procedure. 
&nbsp;

<ul>
	<li>Contralateral Prophylactic Mastectomy (CPM) </li>
</ul>

This procedure removes the healthy breast of a person whose other breast with cancer has been or is being removed. In the US, almost one-third of women under 40 have CPM<a href="#accordion">[3]</a>. 
&nbsp;

<ul>
	<li>Skin-Sparing Mastectomy </li>
</ul>

The procedure involves removing the nipple and areola and then removing the breast tissue through a small incision. 
&nbsp;

<ul>
	<li>Nipple-Sparing Mastectomy </li>
</ul>

The nipple or areola is not touched; just the breast tissue is removed. 
&nbsp;

<ul>
	<li>Double Mastectomy With Reconstruction </li>
</ul>

Both breasts are removed, and they are then reconstructed with implants or tissue from another part of the body. 
&nbsp;

Prophylactic mastectomy is recommended for women who have a high risk of developing breast cancer. The following are some of the indications for prophylactic mastectomy:

<ul>
	<li>&nbsp;Family history of breast cancer</li>
	<li>&nbsp;Genetic mutations such as BRCA1 and BRCA2</li>
	<li>&nbsp;Previous breast cancer diagnosis 
	&nbsp;</li>
</ul>

<div style="border:none #d9d9e3 1.0pt; padding:0in 0in 0in 0in">
<h5>Preoperative Instructions</h5>
</div>

The patient will change into a hospital gown on the day of the operation. A medical professional will next affix an intravenous (IV) line to the patient&rsquo;s arm. The anesthetic (drug) via the IV is meant to calm them down and ensure they stay asleep throughout the surgery. After that, they are taken to the operating room to begin the surgery. 
&nbsp;

The breast surgeon makes an incision in the breast to separate the cancerous breast tissue from the skin and chest muscles and removes it.

If breast reconstruction is part of the surgical plan, then reconstruction will begin at this stage. The surgeon will also insert long tubes to drain excess fluid during the healing process before closing the incision with stitches and covering the area with a bandage.

The surgery typically lasts for 2-3 hours, but if reconstruction is also being done, it may take longer. 
&nbsp;

<div style="border:none #d9d9e3 1.0pt; padding:0in 0in 0in 0in">
<h5>Post-Prophylactic Mastectomy</h5>
</div>

If a person had a preventative mastectomy, they will spend the night at the hospital. The duration of the stay will depend on their general health and whether they underwent reconstruction at the same time or not.

After surgery, a medical professional will teach them some exercises to help with arm or shoulder discomfort. Additionally, these workouts help minimize the chances of the formation of scar tissue.

Before the patient leaves the hospital, their surgical team will give them instructions on how to take care of themselves at home. 
&nbsp;

The procedure offers several benefits, including: 
&nbsp;

<ol>
	<li>Reduce The Risk Of Breast Cancer</li>
</ol>

Prophylactic mastectomy can reduce the risk of developing breast cancer by nearly 90% in women with a strong family history, whereas, in women with a genetic mutation, it can reduce the risk by nearly 95%<a href="#accordion">[4]</a>. 
&nbsp;

<ol start="2">
	<li>Early Detection Of Breast Cancer</li>
</ol>

Prophylactic mastectomy involves the removal of breast tissue, making it easier to detect any cancerous cells that may be present. If any cancerous cells are found, they can be detected at an early stage, increasing the chances of successful treatment. 
&nbsp;

<ol start="3">
	<li>Improved Quality Of Life</li>
</ol>

Women who undergo prophylactic mastectomy often report an improved quality of life due to the reduced anxiety and stress associated with the risk of developing breast cancer. 
&nbsp;

<ol start="4">
	<li>Avoid Chemotherapy And Radiation Therapy</li>
</ol>

Prophylactic mastectomy can eliminate the need for chemotherapy and radiation therapy, which often has significant side effects. 
&nbsp;

<ol start="5">
	<li>Genetic Counseling</li>
</ol>

Women who undergo prophylactic mastectomy often undergo genetic testing to determine if they have a genetic mutation that increases their risk of breast cancer. Genetic counseling can provide valuable information about the risks and options for prevention and treatment. 
&nbsp;

Prophylactic mastectomy is a major surgery, and like any other surgery, it carries risks. The following are some of the complications associated with prophylactic mastectomy: 
&nbsp;

<ol>
	<li>Bleeding And Infection</li>
</ol>

Like any other surgery, prophylactic mastectomy can lead to bleeding and infection. The risk of infection can be reduced with proper wound care and antibiotics. 
&nbsp;

<ol start="2">
	<li>Scarring</li>
</ol>

Prophylactic mastectomy can result in scarring, which can be temporary or permanent. The extent of scarring depends on the type of surgery and the patient&#39;s healing process. 
&nbsp;

<ol start="3">
	<li>Lymphedema</li>
</ol>

Lymphedema is the swelling of the arm due to the removal of lymph nodes. Prophylactic mastectomy can increase the risk of developing lymphedema, which can be a lifelong complication. 
&nbsp;

<ol start="4">
	<li>Emotional And Psychological Distress</li>
</ol>

Prophylactic mastectomy can cause emotional and psychological distress for some women due to the loss of their breasts. The impact of this distress can vary from person to person and can last for an extended period. 
&nbsp;

<ol start="5">
	<li>Complications With Breast Reconstruction</li>
</ol>

Breast reconstruction after prophylactic mastectomy carries its own set of risks. Complications can include infection, bleeding, implant failure, and unsatisfactory cosmetic outcomes. 
&nbsp;

Note: It is essential to discuss the potential risks and benefits of prophylactic mastectomy with a qualified healthcare provider before you make a decision. 
&nbsp;

Breast reconstruction is an option for women who have undergone prophylactic mastectomy and wish to restore the appearance of their breasts. Reconstruction can be performed using breast implants or the patient&#39;s tissue. 
&nbsp;

<h5>Timing Of Breast Reconstruction</h5>

Breast reconstruction can either be done right away following the prophylactic mastectomy (immediate reconstruction) or at a later date (delayed reconstruction). 
&nbsp;

<h5>Types Of Breast Reconstruction</h5>

<ol>
	<li>Implant-Based Reconstruction</li>
</ol>

In implant-based reconstruction, breast implants are used to reconstruct the breast. This type of reconstruction is less invasive than autologous reconstruction and requires less recovery time.

However, implants may require replacement over time, and there is a risk of implant-related complications such as infection, rupture, and capsular contracture. 
&nbsp;

<ol start="2">
	<li>Autologous Reconstruction</li>
</ol>

In autologous reconstruction, the patient&#39;s tissue is used to reconstruct the breast. The tissue can be taken from different parts of the body such as the abdomen, back, or buttocks.

Autologous reconstruction can provide a more natural-looking breast, and there is no risk of implant-related complications. However, it is a more extensive surgery and requires a longer recovery time. 
&nbsp;

<ol start="3">
	<li>Hybrid Reconstruction</li>
</ol>

This is a combination of implant and autologous reconstruction. It provides the benefits of both types of reconstruction. 
&nbsp;

Conclusion

Prophylactic mastectomy is a preventive measure that can reduce the risk of developing breast cancer in women who have a high risk of developing the disease due to their family history or genetic mutations.

The surgery can provide peace of mind for women who are at a high risk of developing breast cancer and can reduce the need for frequent breast cancer screenings. However, the surgery is not without risks, and women should discuss the potential benefits and risks with their doctors before making a decision. It is essential to consider all available options and make an informed decision based on individual circumstances. 
&nbsp;

Key Takeaways

<ul>
	<li>Prophylactic mastectomy is a surgical procedure that involves the removal of one or both breasts in women who are at high risk of developing breast cancer.</li>
	<li>This procedure can significantly reduce the risk of breast cancer in high-risk individuals.</li>
	<li>Women who carry a genetic mutation associated with breast cancer, such as BRCA1 or BRCA2, may consider prophylactic mastectomy as a preventive measure.</li>
	<li>Prophylactic mastectomy can be a challenging decision for women, as it involves the removal of healthy breast tissue, which can have significant physical and emotional implications.</li>
	<li>Breast reconstruction surgery can be performed at the same time as prophylactic mastectomy to restore the appearance of the breasts.</li>
	<li>Evaluation and counseling are necessary before deciding on prophylactic mastectomy to consider all possible options for breast cancer risk reduction.</li>
</ul>

[1] Lostumbo L, Carbine NE, Wallace J. Prophylactic mastectomy for the prevention of breast cancer. Cochrane database Syst Rev. 2010;(11).

[2] Tuttle TM, Abbott A, Arrington A, Rueth N. The Increasing Use of Prophylactic Mastectomy in the Prevention of Breast Cancer. Curr Oncol Rep [Internet]. 2010;12(1):16–21.

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