Skip to main content
SpringerLink
Log in

Prophylactic Mastectomy: Is It Worth It?

  • Review
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Background

Breast cancer is the second mortality-related cancer and the leading cause of general mortality in women aged 40–55. Prophylactic mastectomy has proved to be effective in several clinical scenarios but is still a somewhat controversial procedure.

Methods

We performed a retrospective study by reviewing the records of all patients who underwent prophylactic mastectomy in a 25-year period. We evaluated the aesthetic and long-term oncologic outcomes, complications, and patient satisfaction.

Results

We had 52 patients, 40 of them unilateral cases (contralateral prophylactic mastectomy) and 12 bilateral (bilateral prophylactic mastectomy) for a total of 64 mastectomized breasts. We had 1 (1.56%) case of unexpected breast cancer in the mastectomy specimens. Forty-two (65.62%) cases had a subcutaneous prophylactic mastectomy and 22 (34.37%) cases had a simple total prophylactic mastectomy. Fifty-eight (90.62%) cases underwent reconstruction with alloplastics and 6 (9.37) cases with autologous tissue of which 5 (7.81%) cases received latissimus dorsi flaps with alloplastic implants and 1 (1.56%) case had a TRAM flap. The complications included 4 (6.25%) breasts that developed capsular contracture, 2 (3.12%) cases of hematoma, and 1 (1.56%) infection. Concerning patient satisfaction, 39 (75%) patients reported being highly satisfied, 10 (19.23%) partially satisfied, and 3 (5.76%) unsatisfied. When we performed the aesthetic evaluation according to our scale, we got an overall aesthetic index of 8.8.

Conclusion

Prophylactic mastectomy is becoming an increasingly frequent procedure. Plastic surgeons should consider the aesthetic outcome when planning mastectomy and reconstruction. Our ability to predict the high-risk population has improved and it is that population who can get the best benefit from this intervention. The recommendation against subcutaneous prophylactic mastectomy lacks scientific evidence. There is plenty of evidence that prophylactic mastectomy lowers the risk of breast cancer in the high-risk population in at least 95%. Our experience with prophylactic mastectomy is extremely satisfactory, with an overall patient satisfaction rate of 94%, no mortality, and an oncologic long-term outcome of 0% of ulterior development of breast cancer. Our series, although relatively small, should provide some insight into the power of this technique and we think all plastic surgeons should have it in their surgical armamentarium and should share their experiences so that this procedure may become more widely accepted. We also think that plastic surgeons should strive for perfecting the technique to reduce the complication rate and therefore help the procedure gain acceptance by the medical community.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Greenlee RT, Murray T, Bolden S, Wingo PA (2000) Cancer statistics, 2000. CA Cancer J Clin 50:7–33

    Article  PubMed  CAS  Google Scholar 

  2. Ries LAG, Kosary CL, Hankey BF et al (eds) (1999) SEER cancer statistics review, 1973–1996. National Cancer Institute, Bethesda

    Google Scholar 

  3. Rebbeck TR, Friebel T, Lynch HT et al (2004) Bilateral prophylactic mastectomy reduces breast cancer risk in BRCA1 and BRCA2 mutation carriers: the PROSE study group. J Clin Oncol 22:1055–1062

    Article  PubMed  Google Scholar 

  4. Herrington LJ, Barlow WE, Yu O et al (2005) Efficacy of prophylactic mastectomy in women with unilateral breast cancer: a cancer research network project. J Clin Oncol 23:4275–4286

    Article  Google Scholar 

  5. Armes JE, Trute L, White D et al (1999) Distinct molecular pathogenesis of early onset breast cancer in BRCA1 and BRCA2 mutations carriers: a population-based study. Cancer Res 59:2011–2017

    PubMed  CAS  Google Scholar 

  6. Offit K, Brown K (1994) Quantitating familial cancer risk: a resource for clinical oncologists. J Clin Oncol 12:1724–1736

    PubMed  CAS  Google Scholar 

  7. Osin P, Crook T, Powles T, Peto J, Gusterson B (1998) Hormone status of in situ cancer in BRCA1 and BRCA2 mutations carriers. Lancet 351:1487

    Article  PubMed  CAS  Google Scholar 

  8. Pennisi VR, Capozzi A (1989) Subcutaneous mastectomy data: final statistics analysis. Aesthetic Plast Surg 13:15–21

    Article  PubMed  CAS  Google Scholar 

  9. Schrag D, Kuntz KM, Garber JE, Weeks JC (1997) Decisions analysis: effects of prophylactic mastectomy and oophorectomy on life expectancy among women with BRCA1 or BRCA2 mutations. N Engl J Med 336:1465–1471

    Article  PubMed  CAS  Google Scholar 

  10. Feuer EJ, Wun LM, Boring CC, Flanders WD, Timmel MJ, Tong T (1993) The lifetime risk of developing breast cancer. J Natl Cancer Inst 85:892–897

    Article  PubMed  CAS  Google Scholar 

  11. Armstrong K, Eisen A, Weber B (2000) Assessing the risk of breast cancer. N Engl J Med 342:564–571

    Article  PubMed  CAS  Google Scholar 

  12. Struewing JP, Hartge P, Wacholder S et al (1997) The risk of cancer associated with specific mutations of BRCA1 and BRCA2 among Ashkenazi Jews. N Engl J Med 336:1401–1408

    Article  PubMed  CAS  Google Scholar 

  13. Spear SL, Schwarz KA, Venturi ML, Barbosa T, Al-Attar A (2008) Prophylactic mastectomy and reconstruction: clinical outcomes and patient satisfaction. Plast Reconstr Surg 122(1):1–9

    Article  PubMed  CAS  Google Scholar 

  14. Grann VR, Panageas KS, Whang W, Antman KH, Neugut AI (1998) Decision analysis of prophylactic mastectomy and oophorectomy in BRCA1 positive or BRCA2 positive patients. J Clin Oncol 16:979–985

    PubMed  CAS  Google Scholar 

  15. Grann VR, Whang W, Jacobson JS, Heitjan DF, Antman K, Neugut AI (1999) Benefits and cost of screening Ashkenazi Jewish women for BRCA1 and BRCA2. J Clin Oncol 17:495–500

    Google Scholar 

  16. Hartmann LC, Schaid DJ, Woods JE, Grotty JP, Myers JL, Arnold PG (1999) Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. N Engl J Med 340:77–84

    Article  PubMed  CAS  Google Scholar 

  17. Hamm RM, Lawler F, Scheid D (1999) Prophylactic mastectomy in women with a high risk of breast cancer. N Engl J Med 340:1837–1838

    Article  PubMed  CAS  Google Scholar 

  18. Peralta EA, Ellenhorn JD, Wagman LD, Dagis A, Andersen JS, Chu DZ (2000) Contralateral prophylactic mastectomy improves the outcome of selected patients undergoing mastectomy for breast cancer. Am J Surg 180:439–445

    Article  PubMed  CAS  Google Scholar 

  19. McDonnell SK, Schaid DJ, Myers JL et al (2001) Efficacy of contralateral prophylactic mastectomy in women with a personal and family history of breast cancer. J Clin Oncol 19:3938–3943

    PubMed  CAS  Google Scholar 

  20. Van Roosmalen MS, Verhoef LC, Stalmeier PF, Hoogerbrugge N, van Daal WA (2002) Decision analysis of prophylactic surgery or screening for BRCA mutation carriers: a more prominent role for oophorectomy. J Clin Oncol 20:2092–2100

    Article  PubMed  Google Scholar 

  21. Frost MH, Schaid DJ, Sellers TA et al (2000) Long term satisfaction and psychological and social function following bilateral prophylactic mastectomy. JAMA 284:319–324

    Article  PubMed  CAS  Google Scholar 

  22. Spear SL, Carter ME, Schwarz D (2005) Prophylactic mastectomy: indications, options, and reconstructive alternatives. Plast Reconstr Surg 115(3):891–909

    Article  PubMed  CAS  Google Scholar 

  23. Gabriel SE, Woods JE, O’Fallon WM et al (1997) Complications leading to surgery after breast implantation. N Engl J Med 336:667–682

    Article  Google Scholar 

  24. Spear SL, Majidian A (1998) Immediate breast reconstruction in two stages using textured, integrated-valve tissue expanders, breast implants: a retrospective review of 171 consecutive breast reconstructions from 1989 to 1996. Plast Reconstr Surg 101(1):53–63

    Article  PubMed  CAS  Google Scholar 

  25. Moore TS, Farrel LD (1992) Latissimus dorsi myocutaneous flap for breast reconstruction: long-term results. Plast Reconstr Surg 89(4):666–672

    Article  PubMed  CAS  Google Scholar 

Download references

Disclosure

The authors declare that they have no conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Institute for Plastic Surgery, Vialidad de la Barranca S/N, office 490, Huixquilucan, 52763, Mexico

    Jose Abel de la Peña-Salcedo, Miguel Angel Soto-Miranda & Jose Fernando Lopez-Salguero

Authors
  1. Jose Abel de la Peña-Salcedo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Miguel Angel Soto-Miranda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jose Fernando Lopez-Salguero
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jose Abel de la Peña-Salcedo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

de la Peña-Salcedo, J.A., Soto-Miranda, M.A. & Lopez-Salguero, J.F. Prophylactic Mastectomy: Is It Worth It?. Aesth Plast Surg 36, 140–148 (2012). https://doi.org/10.1007/s00266-011-9769-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00266-011-9769-x

Keywords

Search

Navigation