Bilateral Mastectomy for Breast Cancer

Overview
Mastectomy is surgery intended to remove all breast tissue. Mastectomy to remove one breast is referred to as unilateral mastectomy; if both breasts are removed, it is referred to as bilateral mastectomy. Bilateral mastectomy is a treatment option for women who have cancer in both breasts. Some women who have cancer in one breast choose to undergo bilateral mastectomy in order to reduce their risk of developing breast cancer in the healthy breast as well. In this situation, the procedure is referred to as contralateral prophylactic mastectomy. Other women who have extremely high risk factors for developing breast cancer in the future, but who do not currently have breast cancer, opt to have a bilateral mastectomy to reduce their chances of developing the disease. In these cases, the procedure is also referred to as prophylactic mastectomy or preventative bilateral mastectomy.

Risk factors that lead women to consider bilateral mastectomy include previous breast cancers; a strong family history of breast cancer; testing positive for BRCA1 or BRCA2 or certain other genetic mutations; or conditions such as atypical lobular hyperplasia and lobular carcinoma in situ (LCIS).

Other women decide to have bilateral mastectomies for reasons besides elevated breast cancer risk. Some women experience pain in their breasts from fibrocystic breast disease or other conditions. Others have dense breast tissue and worry that cancer will not be detected by a mammogram. Still others have a phobia about developing cancer, and feel that bilateral mastectomy will provide peace of mind.

Some women who have cancer in one breast choose bilateral mastectomy due to a belief that immediate reconstructive surgery on both breasts will furnish a more symmetrical and natural look. In fact, recent advances in plastic surgery can provide an extremely natural appearance for the affected breast that looks very similar to the healthy breast.

Women who receive magnetic resonance imaging (MRI) scans before surgery are more likely to choose bilateral mastectomies. This may be due to the high rate of false positive results provided by MRIs.

It is important to note that no surgical procedure is guaranteed to completely remove all breast tissue from the body. Some breast tissue can be found in the chest wall, above the collarbone, in the abdomen, or in the armpit area.

It is advisable to obtain genetic counseling before considering bilateral mastectomy. Do not be afraid to ask questions, and be sure you understand all of your options. The more informed you are about the benefits and risks of each option, the more satisfied you are likely to be with your choice. If you choose bilateral mastectomy, psychological counseling can help you prepare for the emotional and social challenge of undergoing and recovering from the procedure.

What does it involve?
The procedure for a bilateral mastectomy is similar to the procedure for a mastectomy. However, the surgery requires more time to perform, and you may need to spend more time being monitored in the hospital and recovering at home before you can resume all of your normal activities.

Intended Outcomes
Bilateral mastectomy can help prevent the development of cancer in the healthy breast while removing tumors and helping prevent the recurrence or spread of breast cancer in the affected breast. In women who do not currently have cancer, but who carry an especially high risk for developing breast cancer, mastectomy can help prevent the disease.

Results
The results of a study published in 2010 indicate that bilateral mastectomy can reduce the risk of developing breast cancer by as much as 100 percent among women who test positive for BRCA genes. Other studies suggest that as many as 10 percent of women who undergo bilateral mastectomies go on to develop breast cancer despite the surgery.

According to a study published in 2010, although bilateral mastectomy reduces the risk for developing cancer in healthy breasts, it does not increase overall survival.

Some experts believe that bilateral mastectomy provides the most benefits to women who are premenopausal and whose cancer is hormone receptor-negative.

Constraints
Constraints for bilateral mastectomy are similar to those for mastectomy. However, since there are two wounds, there is additional discomfort, wound and drain care, and potential for complications. You must also monitor both hands and arms for signs of lymphedema and exercise both shoulders to prevent stiffness.

Any type of surgery carries risks including blood clots, blood loss, infection, breathing problems, reactions to medication, and heart attack or stroke during the surgery.