Preventive Mastectomy: Questions and Answers 

Key Points

• Preventive mastectomy (also called prophylactic or risk-reducing mastectomy) is the 

surgical removal of one or both breasts. It is done to prevent or reduce the risk of 

breast cancer in women who are at high risk of developing the disease (see Questions 

1 and 2). 

• Existing data suggest that preventive mastectomy may significantly reduce (by about 

90 percent) the chance of developing breast cancer in moderate- and high-risk women 

(see Question 3). 

• It is important for a woman who is considering preventive mastectomy to talk with a 

doctor about her risk of developing breast cancer, the surgical procedure and its 

potential complications, and alternatives to surgery (see Questions 2, 4, and 5). 

• Many women who choose to have preventive mastectomy also decide to have breast 

reconstruction to restore the shape of the breast (see Question 6). 

1. What is preventive mastectomy, and what types of procedures are used in 

preventive mastectomy? 

Preventive mastectomy (also called prophylactic or risk-reducing mastectomy) is the 

surgical removal of one or both breasts in an effort to prevent or reduce the risk of breast 

cancer (1). Preventive mastectomy involves one of two basic procedures: total 

mastectomy and subcutaneous mastectomy. In a total mastectomy, the doctor removes 

the entire breast and nipple. In a subcutaneous mastectomy, the doctor removes the 

breast tissue but leaves the nipple intact. Doctors most often recommend a total 

mastectomy because it removes more tissue than a subcutaneous mastectomy. A total 

mastectomy provides the greatest protection against cancer developing in any remaining 

breast tissue. 

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2. Why would a woman consider undergoing preventive mastectomy?

Women who are at high risk of developing breast cancer may consider preventive 

mastectomy as a way of decreasing their risk of this disease. Some of the factors that 

increase a woman’s chance of developing breast cancer include the following 

(2, 3, 4, 5, 6): 

• Previous breast cancer—A woman who has had cancer in one breast is more likely 

to develop a new cancer in the opposite breast. Occasionally, such women may 

consider preventive mastectomy to decrease the chance of developing a new breast 

cancer. 

• Family history of breast cancer—Preventive mastectomy may be an option for a 

woman whose mother, sister, or daughter had breast cancer, especially if they were 

diagnosed before age 50. If multiple family members have breast or ovarian cancer, 

then a woman’s risk of breast cancer may be even higher. 

• Breast cancer-causing gene alteration—A woman who tests positive for changes, 

or mutations, in certain genes that increase the risk of breast cancer (such as the 

BRCA1 or BRCA2 gene) may consider preventive mastectomy. 

• Lobular carcinoma in situ—Preventive mastectomy is sometimes considered for a 

woman with lobular carcinoma in situ, a condition that increases the risk of 

developing breast cancer in either breast. 

• Diffuse and indeterminate breast microcalcifications or dense breasts—Rarely, 

preventive mastectomy may be considered for a woman who has diffuse and 

indeterminate breast microcalcifications (tiny deposits of calcium in the breast) or for 

a woman whose breast tissue is very dense. Dense breast tissue is linked to an 

increased risk of breast cancer and also makes diagnosing breast abnormalities 

difficult. Multiple biopsies, which may be necessary for diagnosing abnormalities in 

dense breasts, cause scarring and further complicate examination of the breast tissue, 

by both physical examination and mammography. 

• Radiation therapy—A woman who had radiation therapy to the chest (including the 

breasts) before age 30 is at an increased risk of developing breast cancer throughout 

her life. This includes women treated for Hodgkin lymphoma. 

It is important for a woman who is considering preventive mastectomy to talk with a 

doctor about her risk of developing breast cancer (with or without a mastectomy), the 

surgical procedure, and potential complications. All women are different, so preventive 

mastectomy should be considered in the context of each woman’s unique risk factors and 

her level of concern. 

 

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3. How effective is preventive mastectomy in preventing or reducing the risk of breast 

cancer?

Existing data suggest that preventive mastectomy may significantly reduce (by about 

90 percent) the chance of developing breast cancer in moderate- and high-risk women (2, 

6, 7). However, no one can be certain that this procedure will protect an individual 

woman from breast cancer. Breast tissue is widely distributed on the chest wall, and can 

sometimes be found in the armpit, above the collarbone, and as far down as the abdomen. 

Because it is impossible for a surgeon to remove all breast tissue, breast cancer can still 

develop in the small amount of remaining tissue. 

4. What are the possible drawbacks of preventive mastectomy? 

Like any other surgery, complications such as bleeding or infection can occur (1). 

Preventive mastectomy is irreversible and can have psychological effects on a woman 

due to a change in body image and loss of normal breast functions (3, 4, 5, 7, 8, 9). A 

woman should discuss her feelings about mastectomy, as well as alternatives to surgery, 

with her health care providers. Some women obtain a second medical opinion to help 

with the decision. 

5. What alternatives to surgery exist for preventing or reducing the risk of breast 

cancer? 

Doctors do not always agree on the most effective way to manage the care of women who 

have a strong family history of breast cancer and/or have other risk factors for the 

disease. Some doctors may advise very close monitoring (periodic mammograms, 

regular checkups that include a clinical breast examination performed by a health care 

professional, and monthly breast self-examinations) to increase the chance of detecting 

breast cancer at an early stage (2, 4). Some doctors may recommend preventive 

mastectomy, while others may prescribe tamoxifen or raloxifene, medications that have 

been shown to decrease the chances of getting breast cancer in women at high risk of the 

disease (2, 4, 8, 10, 11). (More information about tamoxifen and raloxifene is available 

in the National Cancer Institute’s (NCI) fact sheets, Tamoxifen: Questions and Answers, 

which can be found at http://www.cancer.gov/cancertopics/factsheet/Therapy/tamoxifen 

on the Internet, and The Study of Tamoxifen and Raloxifene (STAR): Questions and 

Answers, which can be found at 

http://www.cancer.gov/cancertopics/factsheet/STARresultsQandA on the Internet.) 

Doctors may also encourage women at high risk to limit their consumption of alcohol, eat 

a low-fat diet, engage in regular exercise, and avoid menopausal hormone use (8). 

Although these lifestyle recommendations make sense and are part of an overall healthy 

way of living, we do not yet have clear and convincing proof that they specifically reduce 

the risk of developing breast cancer. 

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6. What is breast reconstruction?

Breast reconstruction is a plastic surgery procedure in which the shape of the breast is 

rebuilt. Many women who choose to have preventive mastectomy also decide to have 

breast reconstruction, either at the time of the mastectomy or at some later time. 

Before performing breast reconstruction, the plastic surgeon carefully examines the 

breasts and discusses the reconstruction options. In one type of reconstructive procedure, 

the surgeon inserts an implant (a balloon-like device filled with saline or silicone) under 

the skin and the chest muscles. Another procedure, called tissue flap reconstruction, uses 

skin, fat, and muscle from the woman’s abdomen, back, or buttocks to create the breast 

shape. The surgeon will discuss with the patient any limitations on exercise or arm 

motion that might result from these operations. 

7. What type of follow-up care is needed after reconstructive surgery? 

Women who have reconstructive surgery are monitored carefully to detect and treat 

complications, such as infection, movement of the implant, or contracture (the formation 

of a firm, fibrous shell or scar tissue around the implant caused by the body’s reaction to 

the implant). Women who have tissue flap reconstruction may want to ask their surgeon 

about physical therapy, which can help them adjust to limitations in activity and exercise 

after surgery (12). Routine screening for breast cancer is also part of the postoperative 

follow-up, because the risk of cancer cannot be completely eliminated. When women 

with breast implants have mammograms, they should tell the radiology technician about 

the implant. Special procedures may be necessary to improve the accuracy of the 

mammogram and to avoid damaging the implant. However, women who have had 

reconstructive surgery on both breasts should ask their doctors whether mammograms are 

still necessary. (More information about mammograms can be found in the NCI fact 

sheet, Screening Mammograms: Questions and Answers, at 

http://www.cancer.gov/cancertopics/factsheet/Detection/screening-mammograms on the 

Internet.) 

8. Where can a person find more information about breast implants?

The U.S. Food and Drug Administration (FDA) regulates the use of breast implants 

and can supply detailed information about these devices. To listen to recorded 

information or request free printed material on breast implants, consumers can contact the 

FDA Center for Devices and Radiological Health (CDRH) at: 

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Address: Consumer Staff

 CDRH/FDA 

 HFZ–210 

 1350 Piccard Drive 

 Rockville, MD 20850 

Telephone: 1–800–638–2041, toll-free

240–276–3103 

(Call between 8:00 a.m. and 4:30 p.m., Eastern Time, for either 

number.) 

E-mail: dsmica@cdrh.fda.gov 

Web site: http://www.fda.gov/cdrh/consumer/index.html 

 http://www.fda.gov/cdrh/breastimplants 

(Breast Implants Home Page) 

Selected References 

1. Singletary SE. Techniques in surgery: Therapeutic and prophylactic mastectomy. In: 

Harris JR, Lippman ME, Morrow M, Osborn CK, editors. Diseases of the Breast. 3rd ed. 

Philadelphia: Lippincott Williams and Wilkins, 2004. 

2. Sherry RM. Cancer prevention: Role of surgery in cancer prevention. In: DeVita VT 

Jr., Hellman S, Rosenberg SA, editors. Cancer: Principles and Practice of Oncology. 

Vol. 1 and 2. 6th ed. Philadelphia: Lippincott Williams and Wilkins, 2001. 

3. Dickson RB, Lippman ME. Cancer of the breast. In: DeVita VT Jr., Hellman S, 

Rosenberg SA, editors. Cancer: Principles and Practice of Oncology. Vol. 1 and 2. 6th

ed. Philadelphia: Lippincott Williams and Wilkins, 2001. 

4. Sakorafas GH. Women at high risk for breast cancer: Preventive strategies. The Mount 

Sinai Journal of Medicine 2002; 69(4):264–266. 

5. Taucher S, Gnant M, Jakesz R. Preventive mastectomy in patients at breast cancer risk 

due to genetic alterations in the BRCA1 and BRCA2 gene. Langenbeck's Archives of 

Surgery 2003; 388(1):3–8. 

6. Anderson BO. Prophylactic surgery to reduce breast cancer risk: A brief literature 

review. The Breast Journal 2001; 7(5):321–330. 

7. Hartmann LC, Schaid DJ, Woods JE, et al. Efficacy of bilateral prophylactic mastectomy 

in women with a family history of breast cancer. The New England Journal of Medicine

1999; 340(2):77–84. 

8. Keefe KA, Meyskens FL Jr. Cancer prevention. In: Abeloff MD, Armitage JO, Lichter 

AS, Niederhuber JE, editors. Clinical Oncology. 2nd ed. London: Churchill 

Livingstone, 2000. 

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9. Levine DA, Gemignani ML. Prophylactic surgery in hereditary breast/ovarian cancer 

syndrome. Oncology 2003; 17(7):932–941. 

10. Fisher B, Costantino JP, Wickerham DL, et al. Tamoxifen for the prevention of breast 

cancer: Current status of the National Surgical Adjuvant Breast and Bowel Project P-1 

Study. Journal of the National Cancer Institute 2005; 97(22):1652–1662. 

11. Vogel VG, Costantino JP, Wickerham DL, et al. Effects of tamoxifen vs raloxifene on 

the risk of developing invasive breast cancer and other disease outcomes: The NSABP 

Study of Tamoxifen and Raloxifene (STAR) P-2 Trial. Journal of the American Medical 

Association 2006; 295(23):2727–2741. 

12. Monteiro M. Physical therapy implications following the TRAM procedure. Physical 

Therapy 1997; 77(7):765–770. 

# # # 

Related NCI materials and Web pages: 

• National Cancer Institute Fact Sheet 3.62, Genetic Testing for BRCA1 and BRCA2: 

It’s Your Choice (http://www.cancer.gov/cancertopics/factsheet/Risk/BRCA) 

• National Cancer Institute Fact Sheet 5.6, Probability of Breast Cancer in American 

Women

(http://www.cancer.gov/cancertopics/factsheet/Detection/probability-breast-cancer) 

• National Cancer Institute Fact Sheet 5.14, Improving Methods for Breast Cancer 

Detection and Diagnosis

(http://www.cancer.gov/cancertopics/factsheet/Detection/breast-cancer) 

• National Cancer Institute Fact Sheet 5.28, Screening Mammograms: Questions and 

Answers

(http://www.cancer.gov/cancertopics/factsheet/Detection/screening-mammograms) 

• National Cancer Institute Fact Sheet 7.16, Tamoxifen: Questions and Answers

(http://www.cancer.gov/cancertopics/factsheet/Therapy/tamoxifen) 

• National Cancer Institute Fact Sheet 7.47, How To Find a Doctor or Treatment 

Facility If You Have Cancer

(http://www.cancer.gov/cancertopics/factsheet/Therapy/doctor-facility) 

• What You Need To Know AboutTM Breast Cancer

(http://www.cancer.gov/cancertopics/wyntk/breast)

For more help, contact: 

NCI’s Cancer Information Service 

Telephone (toll-free): 1–800–4–CANCER (1–800–422–6237) 

TTY (toll-free): 1–800–332–8615

LiveHelp® online chat: https://cissecure.nci.nih.gov/livehelp/welcome.asp

This fact sheet was reviewed on 7/27/06 

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