thinking about bilateral mastectomy for early-stage breast cancer

overview

for years, studies have shown that for early-stage breast cancer, women who have breast-conserving surgery (lumpectomy) followed by radiation treatments live just as long as women who have mastectomy. this was good news for women who wanted to avoid having their whole breast removed.

in recent years, a growing number of women with early-stage cancer have chosen to have both the affected breast and their healthy breast removed. removing both breasts is called a bilateral or double mastectomy.

each woman facing breast cancer has to decide which treatment is right for her. but you don't have to make a decision right away. you can take some time to think about your options and what matters most to you.

what do experts say about bilateral mastectomy?

most experts do not recommend bilateral mastectomy for early-stage breast cancer. this is because:

• women who have both breasts removed don't live longer than women who have lumpectomy plus radiation treatments.^{footnote 1}
• bilateral mastectomy reduces only the risk of a new cancer in the breast. it doesn't reduce the risk of a new cancer in another part of the body.

the risk of a new cancer in the breast is already small. if a new cancer occurs, it's more likely to appear somewhere else in the body.

when is bilateral mastectomy recommended?

having both breasts removed is recommended for women at very high risk of breast cancer. for example, those who have tested positive for a breast cancer (brca) gene change are at very high risk. these high-risk women often have their breasts removed before they get breast cancer. this is called a preventive or prophylactic mastectomy. it can greatly lower their risk of cancer.

having cancer in one breast doesn't put a woman in this very high-risk group. your doctor can help you understand your own personal risk of a new cancer and the best way to manage that risk.

why do some women who are not at very high risk choose bilateral mastectomy?

women may have personal reasons for choosing to remove both breasts. these may include:

• fear of having a new cancer in the healthy breast. even though this risk is low, any risk may feel too great.
• avoiding the stress of future mammograms or breast mris. there is no need for these tests if both breasts are removed. but regular follow-up is needed to watch for a new cancer in other parts of the body.
• wanting their breasts to match. it may be hard to make a reconstructed breast look like the natural breast. the breasts may match better if both are rebuilt at the same time.

what are the pros and cons of bilateral mastectomy?

bilateral mastectomy has some benefits. for example, with this surgery there is:

• a lower future risk of cancer in the breast.
• no need for follow-up mammograms or breast mris.
• a better chance that the breasts will match if both are reconstructed at the same time.

the surgery also has some downsides. bilateral mastectomy:

• has no effect on the risk of cancer somewhere else in your body.
• is more complex than lumpectomy. it takes longer to recover. and there's a higher risk of problems, such as infection.
• causes a loss of feeling in the chest. usually the feeling doesn't come back. and the surgery leaves scars that are permanent.
• may mean that you need one or more other surgeries if you want breast reconstruction. each surgery has risks and requires recovery time.

what else should you know about bilateral mastectomy?

some surgeons may not agree to remove both breasts unless a woman is at high risk of a second breast cancer.

check with your provincial or private health plan to see if breast reconstruction surgery is covered following a mastectomy. some plans may not cover surgery to remove or reconstruct a breast that does not have cancer.

most women are satisfied with the results of the surgery. but some women regret having it. some find that having their breasts removed affects how they feel about themselves. and they may not gain the peace of mind they had hoped for. in general, women are more satisfied when they feel well-informed and take an active role in this decision.

how can you decide what's right for you?

be sure to give yourself time to think through both the medical facts and how you feel about your choices. this is a very personal decision. your feelings are as important as any other factor.

no one else can tell you what's right for you. but it may help to discuss your choices with people who know you well.

if you're thinking about breast reconstruction, it's a good idea to meet with a plastic surgeon. you can ask to see photos and talk to women who've had the surgery.

it might also help to ask yourself some questions, such as:

• can i take time for a longer recovery? or do i need to get back to my life as soon as possible?
• can i accept the small chance of a new cancer in my healthy breast? or would i rather have my breast removed to help make this risk as low as possible?
• do i want to keep the natural look and feel of my healthy breast? or is it more important that my breasts match as well as possible?
• do i have the information i need to make this decision? or do i need to know more before i can make up my mind?