Doctors have seen a concerning trend in recent years: Women diagnosed with cancer in one breast choosing to have double mastectomies to reduce cancer risk in the other breast.
“Following the trauma of a new diagnosis, removing the other breast makes sense to many patients,” said Dr. Anna Seydel, Marshfield Clinic’s breast surgeon.
Many women don’t realize removing the opposite breast doesn’t improve survival from their known breast cancer or significantly reduce their chances of developing a second breast cancer. Some studies, however, do suggest an improvement in quality of life for some women.
Minimal cancer prevention benefit for most patients
Most patients with average risk don’t benefit from having the contralateral, or opposite, breast removed.
“Most patients with a new diagnosis of breast cancer will have much less than a 10 percent chance of developing a cancer in their opposite breast,” Seydel said.
Patients also face a longer operation, longer recovery time and notable increased risk of infection, bleeding and other surgical complications.
“Exceptions are patients who carry BRCA1 or BRCA2 gene mutations – inherited mutations that increase risk of female breast and ovarian cancers. These women can have up to a 40 percent chance of developing a second breast cancer so having the contralateral breast removed is often recommended,” Seydel said.
Breast symmetry is a concern
Cancer prevention isn’t the only reason women ask to have the non-affected breast removed. Some women are concerned their breasts will look uneven after a single-side mastectomy.
“Women can achieve excellent symmetry with tissue reconstruction after a unilateral mastectomy,” Seydel said. “But some women who undergo implant reconstruction experience greater satisfaction when both breasts are reconstructed with implants rather than just one.”
Talk to your surgeon about your options for breast reconstruction before making a decision about double mastectomy.
A personal decision
When patients with cancer in one breast tell Seydel they want a double mastectomy, she talks with them about risks, benefits and other options over multiple visits. They talk about psychological, social, ethical and scientific issues involved in removing both breasts.
“Usually I’ll agree to perform a bilateral mastectomy for peace of mind and symmetry if the patient fully understands the procedure won’t increase overall chance of survival,” Seydel said. “I value and recommend shared decision-making and respect patient autonomy.”