A prophylactic mastectomy is the preventive removal of breast tissue. This procedure is performed primarily in women who have an increased genetic risk of breast cancer. Subsequently, the breasts can be restored with the help of implants so that no change is visually visible.
What is prophylactic mastectomy?
A prophylactic mastectomy is the preventive removal of breast tissue. This procedure is performed primarily in women who have an increased genetic risk of breast cancer. Experts understand a prophylactic mastectomy to be a surgical procedure in which the mammary gland tissue is completely removed without the presence of a specific medical reason. Accordingly, it is a preventive (prophylactic) surgery. Most patients are female, but in some cases men may also undergo such an operation. Tests can be used to determine whether a person has a genetically increased risk of breast cancer. If a risk gene is detected and/or if there are already cases of breast cancer in the family, it is possible to remove the glandular tissue as a preventive measure to avoid the development of cancer. In parallel, removal of the ovaries for the same reason is also possible in women. There are different types of prophylactic mastectomy, which involves either complete or only partial removal of the breast tissue. Which variant is used depends primarily on the patient’s wishes. Prophylactic mastectomy should be avoided without comprehensive counseling and positive genetic evidence as mentioned earlier.
Function, effect, and goals
Prophylactic mastectomy is performed when a patient (or patient; up to 1% of all breast cancers occur in men) is at increased risk for breast cancer. If there are already several known cases of breast cancer in the family of the affected person, there is the option of undergoing genetic testing at a center specializing in breast and ovarian cancer. The result of this test shows whether the patient carries one of the altered risk genes and therefore also has a significantly increased risk of developing breast cancer in the future. If this is detected, a detailed discussion with the experts takes place. Subsequently, the patient has the option to decide for or against a prophylactic mastectomy. In this procedure, the mammary gland tissue is removed so that cancer cells cannot form in it. The procedure belongs to the field of oncology (cancer medicine). The patient can choose between different surgical and reconstructive options. On the one hand, the breast can be removed completely; doctors refer to this as a radically modified mastectomy. The lymph nodes are also removed in order to exclude the possibility of cancer. Reconstruction of the breast is not planned. For this reason, many patients opt for a subtucan mastectomy with simultaneous reconstruction. Whether or not the nipple is retained depends on the individual wishes of the patient. After the tissue is removed, the breast is reconstructed during the same procedure. This part is especially crucial for the patient’s psyche and self-esteem, as the absence of the breast as a feminine feature can often lead to psychological problems later on. Reconstruction is often carried out using the patient’s own tissue. In this case, skin as well as muscle and fat tissue are taken from the patient’s buttocks, thighs or abdomen and used to form a “new” breast. Even though this type of surgery is comparatively complex, very satisfactory results can be achieved. Alternatively, the breast can be reconstructed with the help of a silicone implant, which is implanted under the skin in place of the missing mammary gland tissue. In this case, the operation time is significantly shorter, which means that the procedure is less stressful for the organism. Provided that high-quality and anatomically suitable implants are used, visually good results can also be achieved with the help of these foreign bodies.
Risks, side effects and dangers
A prophylactic mastectomy is a surgical procedure and thus naturally already entails certain risks.A detailed examination of the patient and an appropriate physical constitution are thus prerequisites for the operation to take place at all. Especially the reconstruction of the breasts with autologous tissue is a great strain on the body, since surgery is performed in several places at the same time and thus several potential sites of inflammation are present. Healing also usually takes a little longer, since several and larger wounds are involved. On the other hand, with autologous tissue there is no risk of rejection, as can occur when a silicone implant is inserted. If severe and permanent pain, swelling and inflammation occur after the operation, the implant must be removed. If it remains in the breast, it is not uncommon for so-called capsular fibrosis to occur, a hard capsule that develops as a result of a foreign body reaction and that can cause pain. If the patient forgoes breast reconstruction, psychological impairment is to be expected, since breasts are generally regarded as a typical female feature and women without breasts often see themselves as “not female”. Appropriate therapeutic support is advisable here. Prophylactic mastectomy is a controversial procedure among many people, as it is performed without an actual medical need on a genetic suspicion. Removing the female breast represents a major change for the body, which is why people often oppose the surgery. In fact, however, it is at the discretion of each individual patient whether she decides for or against prophylactic mastectomy. It is important to have individualized guidance from competent medical professionals as well as comprehensive education.
