Question: What is a prophylactic mastectomy and am I still at risk for breast cancer if I have this surgery?
Answer: 'Prophylactic mastectomy' just implies that you're having all the breast tissue removed -- and, in general, if it's done on both sides, if you haven't had breast cancer. Or in many cases, it's done on the opposite side, where the breast cancer recurs.
There are few indications for prophylactic mastectomy medically. One is the BRCA1 and BRCA2 genes -- that when the patient had these mutated genes, their chance of developing cancer in their lifetime approaches 70 percent. So we encourage the patients and discuss with the patients the possibility of having a prophylactic mastectomy, which is just removal of all the breast tissue. There's also a patient population that's had breast cancer and has been treated, and they do not want to run the risk of getting cancer in the opposite breast; so in that scenario, the opposite breast is removed.
Is there a chance of recurrence or getting breast cancer with a prophylactic mastectomy? Yes, albeit quite small. For someone who has really had a total mastectomy, the chance of developing cancer in their breast is less than 5 percent. And so we instruct the patients that, again, to be aware of that and to continue to check themselves, especially if they've had breast cancer -- or even if they haven't had breast cancer -- to be sure and check their skin and soft tissues around the breast and chest wall, to be sure there's no evidence of developing cancer or developing a recurrence.