Breast Cancer After Prophylactic Mastectomy

Breast cancer is a concern for many women in America. There are many options to minimize the chances of developing the disease later in life for those women with a high risk of developing breast cancer. One of those options is a prophylactic mastectomy, a surgical procedure to remove one or both breasts to prevent cancer development.

The timing of a prophylactic mastectomy is essential and can significantly impact a woman’s quality of life. Factors including age, personal goals, fitness, and childbearing can significantly impact the timing and the physical/emotional changes to the body.

A common question for women who undergo a prophylactic mastectomy is: Can breast cancer occur after a prophylactic mastectomy?

What are the Chances of Developing Breast Cancer After a Prophylactic Mastectomy?

Generally, the chances of developing breast cancer after a prophylactic mastectomy are considerably low. However, it is essential to understand why breast cancer can develop even after a woman undergoes a prophylactic mastectomy.

During a mastectomy, a majority of the patient’s breast tissue is removed. However, there may be a few areas where a microscopic amount of breast tissue is unable to be removed. It is impossible to completely remove every single breast cell, even via mastectomy, because:

1. Some breast tissue is present directly underneath the skin.
2. It may be challenging to differentiate breast tissue from adipose (fat) tissue within the breast.
3. Women who decide to have a nipple-sparing mastectomy have a microscopic amount of ductal tissue contained within the nipple.

Breast cancer can develop within these microscopic areas of remaining breast tissue. It is important to continue routine examinations (by you and your doctors) and regular imaging tests (if recommended).

If one breast has been removed, there is a 0.2% – 0.4% chance per year that cancer will develop in the other breast. In cases where both breasts are removed, the odds of cancer relapsing is slightly higher at an increase of 0.6% per year but does not exceed a 2% overall incidence rate. Women who have tested positive for BRCA have a slightly higher risk of redeveloping breast cancer after mastectomy, a rate of 3% per year.

Genetics Plays an Important Role

Genetic testing plays a vital role in determining a woman’s risk for breast cancer if there is a strong family history. A common gene mutation screened for genetic testing is the BRCA (BReast CAncer) genes. The two most well-known genes are BRCA1 and BRCA2. Patients with either the BRCA1 or BRCA2 gene have been found to have an increased chance of developing breast cancer and other cancers, such as ovarian cancer.

When normal, the BRCA genes are essential in directing normal DNA and cell repair. Normal DNA and cell repair are necessary to prevent the formation of tumors. When there is a mutation in the BRCA genes, DNA and cell repair can be abnormal, increasing the risk of developing breast cancer.

Genes are passed down from generation to generation. A family history of positive BRCA test results means that women may be at a higher risk of developing breast cancer. A damaged BRCA gene significantly increases the chances of contracting breast cancer to as high as 72%, with the risk rising as a woman ages. Given our understanding of the role genetics have on breast cancer development and increase screening, it is no surprise that prophylactic mastectomies have become more common.

A Prophylactic Mastectomy is Still a Valid Option

Studies of thousands of BRCA-positive women, who underwent a prophylactic mastectomy, show an 85% reduction in overall breast cancer risk. These same studies also showed a high quality of life after the surgery, with over 90% expressing increased satisfaction with their results.

The Reconstruction Surgery

While a prophylactic mastectomy does not completely remove the risk of developing breast cancer, it dramatically reduces the chance of developing cancer. It is also an effective means to reduce the risk of developing breast cancer in patients with a genetic risk of developing it. Most importantly, undergoing a prophylactic mastectomy allows women to live a full and meaningful life.

If recommended, it is best to undergo genetic testing, not just for the BRCA genes but also for more obscure sequences such as PALB2. If a prophylactic mastectomy is recommended, make sure to see a board-certified plastic surgeon, to discuss all options for breast reconstruction. We have the necessary skills and experience to advise you on the reconstructive steps properly, whether it be an implant-based reconstruction, tissue-based (autologous) reconstruction, or nipple-preserving mastectomy.