What is breast cancer risk reduction surgery?

​

Prophylactic or risk-reducing surgery is one of the resources that can be used by women who are at high risk of developing breast cancer. Surgical resources are prophylactic mastectomy or adenectomy. The technique is based on the removal of glandular breast tissue, with total preservation of the skin and immediate reconstruction, with a silicone implant or filling the breast with intra-abdominal fat tissue or with a skin and fat flap from the abdominal wall or back.

It is noteworthy that no mastectomy technique can guarantee the total removal of the mammary gland, due to the impossibility of defining its real limits, since it is very intimate with the skin and extends to the armpit. Surgery is estimated to provide a 90% risk reduction, so the more radical the surgery, the greater the protection.

Prophylactic mastectomy can be applied in three situations: synchronous contralateral mastectomy for the treatment of the primary tumor, metachronic, when performed in a second step, and bilateral procedure in high-risk women.

The benefit of prophylactic surgery varies according to the risk of developing the disease: in women with a lifetime risk of 40%, prophylactic surgery adds three years of life; in those where the risk is 85%, this number rises to more than five years.

In the case of a first-degree relative with breast cancer, the ideal is that the mastectomy is performed before the patient reaches the age of diagnosis of the first-degree relative. However, doctors recommend preventive mastectomy only for women who already have children.

An evaluation must be carried out by a multidisciplinary team: breast cancer specialist, oncologist, plastic surgeon, psychologist and geneticist to define whether there is an indication for surgery, to know if the patient is prepared for an eventual unsatisfactory aesthetic result, to define the best surgical technique and best option for reconstruction. The individualized selection of the patient is essential.