Thinking About Bilateral Mastectomy for Early-Stage Breast Cancer

Overview

People with early-stage breast cancer who have breast-conserving surgery (lumpectomy) followed by radiation treatments live just as long as people who have mastectomy.

Some people with early-stage cancer choose to have both the affected breast and the breast without cancer removed. Removing both breasts is called a bilateral or double mastectomy.

Each person facing breast cancer has to decide which treatment is right for them. If you are facing this decision, you likely don't have to decide right away. You can take some time to think about your options and what matters most to you.

What do experts say about bilateral mastectomy?

Most experts do not recommend bilateral mastectomy for early-stage breast cancer. This is because:

• People who have both breasts removed don't live longer than people who have lumpectomy plus radiation treatments.^{footnote 1}
• Bilateral mastectomy reduces only the risk of a new cancer in the breast. It doesn't reduce the risk of a new cancer in another part of the body.

The risk of a new cancer in the breast is already small. If a new cancer occurs, it's more likely to appear somewhere else in the body.

When is bilateral mastectomy recommended?

Having both breasts removed is recommended for some people at high risk of breast cancer. For example, those who have tested positive for a breast cancer (BRCA) gene change are at high risk. These high-risk people often have their breasts removed before they get breast cancer. This is called a preventive or prophylactic mastectomy. It can greatly lower their risk of cancer.

Having cancer in one breast doesn't put someone in this high-risk group. Your doctor can help you understand your own personal risk of a new cancer and the best way to manage that risk.

Why do some people who are not at very high risk choose bilateral mastectomy?

People may have personal reasons for choosing to remove both breasts. These may include:

• Fear of having a new cancer in the breast that doesn't have cancer. Even though this risk is low, any risk may feel too great.
• Avoiding the stress of future mammograms or breast MRIs. There is no need for these tests if both breasts are removed. But regular follow-up is needed to watch for a new cancer in other parts of the body and to check for cancer in your chest.
• Wanting their breasts to match. It may be hard to make a reconstructed breast look like the natural breast. The breasts may match better if both are rebuilt at the same time.

What are the pros and cons of bilateral mastectomy?

Bilateral mastectomy has some benefits. For example, with this surgery there is:

• A lower risk of a new breast cancer.
• No need for follow-up mammograms or breast MRIs.
• There may be a better chance that the breasts will match if both are reconstructed at the same time.

The surgery also has some downsides. Bilateral mastectomy:

• Has no effect on the risk of cancer somewhere else in your body.
• Has no effect on the chance that the cancer will come back in your chest.
• Is more complex than lumpectomy. It takes longer to recover. And there's a higher risk of problems, such as infection.
• Causes a loss of feeling in the chest. Usually the feeling doesn't come back. And the surgery leaves scars that are permanent.
• May mean that you need one or more other surgeries if you want breast reconstruction. Each surgery has risks and requires recovery time.

What else should you know about bilateral mastectomy?

Some surgeons may not agree to remove both breasts unless someone is at high risk of a second breast cancer.

Insurance companies that offer mastectomy coverage must also provide coverage for reconstructive surgery after mastectomy. But there's a chance that they may not pay to remove or reconstruct a breast that doesn't have cancer.

Your breasts may not look alike after bilateral mastectomy and reconstruction. One reason for this is if radiation was needed.

If having your breasts look alike is important to you, bilateral mastectomy and reconstruction is not your only option. People can have breasts that match after lumpectomy. And surgery could be done on your breast without cancer so it looks more like your breast that had a lumpectomy.

Most people are satisfied with the results of the surgery. But some people regret having it. Some find that having their breasts removed affects how they feel about themselves. And they may not gain the peace of mind they had hoped for. In general, people are more satisfied when they feel well-informed and take an active role in this decision.

How can you decide what's right for you?

Be sure to give yourself time to think through both the medical facts and how you feel about your choices. This is a very personal decision. Your feelings are as important as any other factor.

No one else can tell you what's right for you. But it may help to discuss your choices with people who know you well.

If you're thinking about breast reconstruction, it's a good idea to meet with a plastic surgeon. You can ask to see photos and talk to people who've had the surgery.

It might also help to ask yourself some questions, such as:

• Can I take time for a longer recovery? Or do I need to get back to my usual activities as soon as possible?
• Can I accept the small chance of a new cancer in my breast that doesn't have cancer? Or would I rather have my breast removed to help make this risk as low as possible?
• Do I want to keep the natural look and feel of my breast that doesn't have cancer? Or are other things more important to me?
• Do I have the information I need to make this decision? Or do I need to know more before I can make up my mind?