Clearly, the ideal would be to have another, non-surgical intervention that was highly effective. Unfortunately the process of carcinogenesis, or cancer development, is extremely complex and can occur via a number of biologic pathways. Thus, removing the tissue at risk remains an option for select individuals at high-risk. A subcutaneous mastectomy removes the large majority of breast tissue but preserves the nipple and a small amount of breast tissue just below the nipple. It was done for a better reconstructive result.
Today there are improved, alternative procedures for breast reconstruction.
Hence, for a high-risk woman who elects prophylactic mastectomy today, most surgeons perform a total mastectomy. The subcutaneous mastectomy is a specialized procedure and many women were referred to Mayo Clinic specifically to have it performed. It seems paradoxical that a woman can have breast conservation if she has breast cancer, but we consider bilateral mastectomy when she does not have cancer. Those are two very different clinical situations. The other woman, for whom prophylactic mastectomy is a consideration, is at high-risk, and thus, all her breast tissue is at high risk for the later development of a breast cancer.