Robert J. Allen M.D.

Prophylactic Mastectomy – On The Rise

August 1st, 2012 admin

A prophylactic mastectomy is a surgery to remove one or both healthy breasts to reduce one’s risk of developing breast cancer.  This procedure is a common and increasing trend within the breast cancer community today, and for good reason.  According to the National Cancer Institute, prophylactic mastectomies in high risk women may decrease their breast cancer risk by upwards of 90%.

Therefore, who is considered high risk?  There are various accepted measures that indicate one’s risk for breast cancer, and possessing any or all will likely put you in a high risk category in which risk reducing measures can or should be considered.  The following is a list of accepted high risk indicators for breast cancer:

  • Strong family history – mother, sister, aunt, grandmother
  • Tested positive for BRCA1 or BRCA2 gene mutations
  • Personal history of breast cancer – have or had in other breast
  • Radiation therapy to the chest prior to the age 30

What does a prophylactic mastectomy entail?  A prophylactic mastectomy is a simple or total mastectomy in which the breast tissue is completely removed, avoiding dissection of the axillary lymph nodes.  It may be skin or nipple sparing as well.  Similar to standard mastectomies, a prophylactic mastectomy runs the same surgical risks and physiological outcomes.

Breast reconstruction is also an option for those undergoing prophylactic mastectomies.  As with any type of mastectomy, there are various methods of reconstruction that may take place at any stage of the process, although immediate reconstruction with a skin and nipple sparing mastectomy offers the most aesthetically pleasing result.

If you have any of the high risk factors for breast cancer, speak with your healthcare provider about considering risk reducing methods such as prophylactic mastectomy.  Remember, all risk reducing measures are risk reducing, not risk canceling, and is never a guarantee that breast cancer cannot or will not develop.

Tissue Preserving Mastectomies

June 26th, 2012 admin

When radical mastectomies became a thing of the past, so did its medical mindset.  Because research has shown that the radical mastectomy is no more effective than less extreme forms of mastectomy, but only significantly more disfiguring and difficult to reconstruct, the medical community has since focused on tissue preservation and the concept that “less isn’t always more.”  For mastectomies, such tissue preservation takes on many forms and available options vary directly with a patient’s specific condition.

A modified radical mastectomy (MRM ) is a less extreme and widely used form of mastectomy.  Unlike its predecessor, the MRM only removes the breast tissue and axillary lymph nodes, leaving the pectoralis muscle in place and intact.  Similar to the modified, a total mastectomy does the same, only without axillary lymph node dissection.  For both, the breast skin may or may not be removed.

A skin sparing mastectomy (SSM) is a total or modified radical mastectomy with the preservation of the breast skin.  This form of mastectomy allows for a very pleasing reconstructive result, as it provides a breast envelope for shape and volume to be restored.  Both immediate and delayed reconstruction can take place with SSM.  However, a later procedure will be required to recreate the nipple and areola.

A nipple sparing mastectomy (NSM) is a skin sparing mastectomy with the preservation of the nipple/areola complex.  As far as complete mastectomies go, this is the least extreme, most tissue preserving technique and is ideal for immediate reconstruction.  Both the mastectomy and reconstruction take place through a single lateral or vertical incision, and the nipple remains in place and intact.  However, studies have shown that although the nipple/areola complex is preserved, it may never regain any sensation.

As a note, leaving any tissue behind always poses a risk.  For this reason, not all breast cancer patients are candidates for every type of tissue preserving mastectomy.  If you are considering a mastectomy and reconstruction, meet with your breast surgeon to determine the criteria your condition meets and what tissue preserving mastectomy may be suitable for you.