Angelina Jolie brought preventative mastectomy surgery into the public spotlight in 2013 when she underwent the procedure following genetic profile testing, which confirmed that she was carrying the BRAC-1 gene mutation. Her mother’s death due to breast cancer prompted her to have the testing - and subsequent surgery to remove her breasts in an aim to prevent the disease from forming in her body. Jolie opted to have a breast reconstruction to replace the lost breast tissue. The BRAC-1 gene mutation is linked to the development of breast cancer in women and men, and many are now choosing to have both breasts removed, in what is described as a bilateral preventative mastectomy.
This is a deeply personal decision and one that is made after testing, counselling and consideration. You may consider having a preventative mastectomy if you have a strong family history of breast cancer and/or if genetic testing suggests a strong likelihood that you may be diagnosed with breast cancer in future. Preventative mastectomy is a big decision. It involves much consideration, consultation with healthcare professionals and genetic counselling.
Preventative mastectomies remain a contentious issue amongst many medical professionals, as there is concern over health breasts – that may never develop cancer – being removed ‘just in case’, particularly at a young age. The overwhelming feedback from women who have chosen to undergo a preventative mastectomy is that what they have lost in breast form or function, they have gained through relief from the anxiety and constant fear of developing the cancer that has often robbed them of a close family member.
FREQUENTLY ASKED QUESTIONS ABOUT PREVENTATIVE MASTECTOMY SURGERY + RECONSTRUCTION
Are there different types of preventative mastectomies?
The procedure can be performed as nipple-sparing (whereby the nipple is left) or total, or ‘radical’ whereby all tissue and skin – including the nipple – are removed. In these cases, the nipple can be reconstructed using tissue from elsewhere on the body, which is expertly transplanted onto the reconstructed breast and then 3D tattooed by a medical cosmetic tattooist to resemble a nipple. After a preventative mastectomy, women cannot breastfeed as their milk ducts are removed, so this is one of the many issues women must consider when undergoing a preventative mastectomy prior to having children.
What are the first steps if I want to talk to a professional about this procedure?
Dr Sharp recommends anyone with a family history of breast cancer who is considering preventative mastectomy surgery to discuss this option with their General Practitioner, and if they are interested in investigating this further, request a referral to a genetic counsellor. If you test positive for the gene, you can be referred to a breast surgeon and reconstructive plastic surgeon to discuss your removal and reconstruction options.
What reconstructive options are available after preventative mastectomy surgery?
There are many different options available for reconstruction - and many different factors to consider - especially in the early period after confirmation that you are carrying the gene mutation. Understandably, this can be an overwhelming period, which is why it’s important to find a treating team that will take time ensure you are properly informed of your options, listen to your concerns and allow you the space and time to make your decisions. As part of this, you may ask for a referral to a plastic surgeon to discuss what is best for you and connect with other women who have had a reconstruction.
Surgical reconstruction techniques can differ between surgeons. You should never feel uncomfortable or embarrassed asking your surgeon about their training and experience with each technique, particularly the more modern, advanced microsurgical procedures now available. It’s your body, and you’ll be the one living with the outcome of their expertise, so ask your surgeon as many questions as you need – even the uncomfortable ones!
Women who decide to have a breast reconstruction after a preventative mastectomy most often choose to have their breast reconstruction at the same time as mastectomy, this is called an immediate reconstruction. However, you may not feel ready to make such a commitment at the time of your mastectomy - and some women decide that they do not want to have a breast reconstruction at all. If this is your choice, you have the option of using an external breast prosthesis. Having a breast reconstruction later on - months or years after a mastectomy - is called delayed breast reconstruction. It is always option later, if you change your mind.
If you choose to have a mastectomy without breast reconstruction, the surgeon may remove the breast skin, areola and nipple. If you decide to have a breast reconstruction later, the remaining skin may need to be stretched to accommodate a breast shape. Alternatively, skin and tissue from another part of the body can be used to replace the skin that has been removed surgically.
Will I have both or just one breast removed?
Most women who have a preventative (prophylactic) mastectomy have both breasts removed (bilateral mastectomy).
What will I look like following a preventative mastectomy?
If you are having a preventative (prophylactic) mastectomy, it is usually possible to preserve the skin over the breast, the areola and the nipple. Breast reconstruction following preventative mastectomy will usually involve replacing the underlying tissue only. This means that the reconstructed breasts are likely to look more similar to the original breasts. There will always be some differences in shape and feel, depending on the type of breast reconstruction. Having both breasts reconstructed means they are more likely to be more symmetrical.
It is important to remember that the aim of breast reconstruction surgery is to create a natural shape when you are clothed; your new breast will not look the same, or feel the same, as the breast you have had removed.
Can I access breast reconstruction publicly or privately?
Breast reconstruction following a mastectomy for breast cancer is available in the public hospital system as well as through the private health system. It is considered a medical procedure, not cosmetic surgery. If your treating team has not discussed the full spectrum of reconstructive options available, ask to be referred to a specialist plastic surgeon in your area. Dr Sharp performs breast reconstruction surgery at private hospitals in Brisbane and Ipswich.