For women with extensive history of breast cancer in their family, a preventive mastectomy can be performed to eliminate the risk for cancer. Because the cancer does not exist at the time of surgery, the patient is allowed more time to plan and decide if the treatment is right for her.
With the advent of genetic testing, many women find that they are at
significantly increased long-term risk of developing breast cancer. They're
choosing to have mastectomies, in fact, before they're even diagnosed with
breast cancer. This is called a prophylactic preventative mastectomy.
They're generally done on both sides at the same time. One of the nice
things about prophylactic mastectomies for the patient is that because they
do not have cancer they're not under time pressure restraints to make the
decisions, so we're allowed to approach the reconstruction as we want.
We have the luxury of time to make decisions about how we want to form the
reconstruction, and to do it in a slightly different way with lower risk to
the patient than patients who actually have breast cancer. With the newer
techniques available today, with the use of the newer tissue expanders and
AlloDerm, it's possible to give women a very natural, long-term
reconstruction without resulting in taking tissue from other areas of the
body. No scars elsewhere on the body with relatively short operations.
Many women who have prophylactic mastectomies are candidates for nipple
septectomies. During traditional mastectomies, the nipple and areola are
removed with the breast tissue. During nipple septectomies that tissue is
left behind, which can provide a more natural look, both in terms of the
shape of the breast because we haven't removed any additional skin and
because a woman retains her natural nipple and areola.