We teach you about bilateral or “double mastectomies.” You will learn about the advantages, disadvantages, and controversy of this approach to reducing your future risk for a new breast cancer.

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Questions for your Breast Surgeon:

1. Will I improve my chances of survival with a “Bilateral Mastectomy?”
2. What are the disadvantages of a “Bilateral Mastectomy?”
3. What are the advantages of a “Bilateral Mastectomy?”
Isn’t it my choice to decide?
4. If I’m unsure, can I talk to a plastic surgeon?
5. What is a “Bilateral Mastectomy”?

Also called a “double mastectomy,” this is when both breasts are surgically removed. The term “Contralateral Prophylactic Mastectomy” is also used by the medical community for removal of the opposite, non-cancerous breast. Most of the time the decision to have a bilateral mastectomy is a personal one and is not required to treat a breast cancer that is on one side.

There are situations where a “bilateral mastectomy” may be offered for consideration by your breast surgeon. The medical aspects are more complicated than listed below, but we include some common scenarios.

Cancer in both breasts
BRCA (“breast cancer gene”) mutation or other high-risk genetic mutation
Strong family history of breast cancer
Younger than 35 with breast cancer
High risk for developing a new cancer
Radiation to your chest at a young age

Am I at risk of developing a “New Breast Cancer” in my other breast?

Simple statistics are important to understand this concept. Below is a common scenario where women consider undergoing bilateral mastectomies to treat their existing cancer and reduce the risk of developing a new cancer in the other breast.

Let’s say you are 45 years old, have an early, Stage I or II breast cancer and either need or have chosen to have a mastectomy to treat your cancer effectively. What is your risk of developing a new breast cancer in the other breast in the future?

If you were just diagnosed with breast cancer and have no other risk factors, you will have a slightly higher overall risk of developing a totally new breast cancer in your lifetime. This risk rises from the normal lifetime risk of 8% for both breasts to approximately 12%, assuming a lumpectomy is performed and you keep both breasts.

If you are in this situation and are trying to decide if you want a bilateral rather than a mastectomy on one side, your risk of developing a new cancer in your lifetime in the other breast if you choose to keep it is about 6% (half of the 12% above). We cure about 90% of all breast cancers with current treatments. Therefore, your lifetime chance of dying from a new cancer in that other breast will be about 0.6%.

“Bilateral Mastectomy” for cancer on one side?

Most of the time the choice to have a bilateral mastectomy is a personal one for a variety of reasons. Even when well informed, many women decide to proceed with removing both breasts for “peace of mind” and the desire to “never go through this again.” It is important to realize that everyone has different goals, unique personal situations, and their own reasons as to how they manage their own breast cancer. “Patient autonomy” is essential to a great “doctor-patient” relationship.

Controversy about “Contralateral Prophylactic Mastectomy”

There has been a trend over the last decade of more women choosing a “double mastectomy” when they have cancer in one breast. About 25 to 50% of all mastectomy surgeries done today are “bilateral” procedures. The more informed you become, the better decision you will make for your own situation.

There is an intense debate by breast specialists as to whether too many bilateral mastectomies are being performed.

What are the “disadvantages” of a bilateral mastectomy?

Surgical complication risks are slightly increased
Loss of sensation in the skin of both breasts
Increased need for revision surgeries in the future
Does not improve your “overall survival” from breast cancer
Does not lessen the chance you will need chemotherapy
A chance you might regret the decision in the future

What are the “advantages” of a bilateral mastectomy?

Lessens the chance of a new cancer in the breast
Screening mammograms are no longer needed
Cosmetic outcomes have improved over the last decade
Reconstructing both sides gives matching cosmetic outcomes

Discuss with your Breast Surgeon

Work to develop a close relationship with your breast surgeon. Print out and take these course notes with you when covering this topic. Ask to see a plastic surgeon about reconstruction options if you are unsure. Ultimately, your breast cancer treatment decisions are yours to make.

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