The question of breast cancer risk reduction surgery

Breast Cancer Awareness Month

Many women have had personal experience with breast cancer, be it themselves or someone they know who’s had or currently has breast cancer. And yet, when I was asked by a healthy 35-year-old woman planning her cosmetic breast augmentation, “can I have a mastectomy at the same time as the augmentation to prevent breast cancer?”, it made me do a double-take.

What she was really asking about is a prophylactic mastectomy. And she’s not the only one who’s heard about it, as it was widely publicised following actress Angelina Jolie’s personal experience of the surgery. It is also known as risk reduction mastectomy or preventative mastectomy – an elective surgical procedure to remove one or both breasts with the aim of reducing the risk of developing breast cancer.

It differs greatly in nature from a cosmetic breast augmentation, in which a breast implant is placed beneath the breast mound or pectoral major muscle to enhance the shape and volume of the breast. A risk-reduction mastectomy on the other hand is a medically indicated surgery to remove the breast tissue while sparing the relatively thin overlying skin and the nipple-areolar complex. Reconstruction is usually done at the time to restore the shape and volume of the breast after tissue removal.

Risk reduction mastectomy is done, in most cases, for high-risk individuals. Above advancing age and being female, the risk is higher in individuals with:

  • A strong positive family history of breast cancer.
  • A personal history of breast cancer in one breast and a high risk of developing cancer in the other breast.
  • Previous radiation treatment to the chest wall before 30 years old.
  • A positive genetic test for BRACA1 or 2 or other genes associated with breast cancer risk.

While it has been shown to significantly lower the risk of developing breast cancer in high-risk individuals, the surgery does not guarantee a zero risk. This is because the surgery cannot entirely remove all the breast tissue, especially at the very edges of normally occurring breast tissue or on the chest wall. The decision to have risk reduction surgery is not to be taken lightly. It has potential complications of bleeding, infection, altered sensation, pain, change in body image, re-operation and problems relating to breast reconstruction.

Thus, risk reduction surgery isn’t merely an opt-in surgery to be paired with cosmetic breast augmentation surgery. If you are concerned about the risk of developing breast cancer speak to your GP, or a breast surgeon, to be referred to a genetic counsellor. A genetic counsellor will have an in-depth discussion with you to gather a detailed history about you, your health and your family history with cancer to help you understand your personal risk profile.

This breast cancer awareness month you can arm yourself with the right tools to protect yourself, and the ultimate tool is knowledge. Here are some best practices you can use to help detect early breast cancer.

  1. Do regular breast self-examination. Become familiar with your breasts – the size, appearance and consistency to recognise changes through monthly breast self-examination. BSE from the CANSA website
  2. Have a yearly clinical breast examination and breast screening investigations such as mammogram, ultrasound and MRI based on local guidelines.
  3. Last but not least, embrace a healthy lifestyle. Maintaining a healthy weight through a healthy diet and regular exercise, avoiding smoking and alcohol goes a long way to reducing your risk of disease.

If you have any questions about plastic surgery procedures, feel free to get in touch with me.