The double mastectomy: an FAQ

This recent news report – which claims that the rate of women opting to undergo a double mastectomy has soared in recent years – is an excellent excuse to talk about CPM – contralateral prophylactic mastectomy, or more accurately, risk reducing mastectomy (RRM)

While it can be a necessary procedure when cancer has spread to both breasts, a lot of women choose to have both breasts removed when cancer has been detected in one as a preventative measure. And certain women choose to undergo a double mastectomy when there are no indications of cancer in either breast, to ensure they never suffer from breast cancer in later life.

Why would someone without cancer decide to have a double mastectomy?

There are many reasons, but the main ones are:

There’s a history of cancer in the family: As we know, women with relatives who developed breast or ovarian cancer before the age of 50 are more likely to develop breast cancer themselves. That’s the reason why Angelina Jolie chose to undergo the procedure in 2013. As she wrote in an article in the New York Times; “My mother fought cancer for almost a decade and died at 56. My doctors estimated that I had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer…once I knew that this was my reality, I decided to be proactive and minimise the risk as much as I could.”

BRCA1 or BRCA2 gene mutation fears: BRCA1 and 2 are genes that produce proteins which help in the repair of damaged DNA and stabilise the genetic material in a cell. When they mutate, the production of proteins cease and the cells become more susceptible to genetic alterations that could lead to the development of cancer. According to scientific data, BRCA 1 or 2 gene mutations ramp up the risk of cancer considerably: approximately 55-80% of women with BRCA1 mutation will develop breast cancer by the age of 70, while 45% of women with BRCA2 mutation will develop breast cancer by the age of 70. A DNA test can determine whether BRCA1 or 2 gene mutation is present in the body.

There’s already been a case of LCIS: Lobular carcinoma in situ is found in the in the glands that produce breast milk. It’s not a cancer as such, but it can be an early signifier for breast cancer. According to recent studies, between 20-40% of women with LCIS will develop a separate invasive breast cancer.

How effective is a double mastectomy?

Very effective – but it’s worth bearing in mind that the term ‘breast cancer’ can be a misnomer, as breast tissue is also located in the armpits and above the collarbone. However, the vast majority of breast cancer occurs in the breast area, and it is estimated that double mastectomy procedures have a 95% reduction rate for breast cancer.

What are the side effects of a double mastectomy?

There will be a one to two week recovery period. As with all invasive procedures, there is a small risk of infection and the tissue failing to heal, requiring further surgery. Just as important is the risk of emotional side-effects linked to body image and self-esteem due to undergoing such a procedure.

Is it possible to have a breast reconstruction procedure?

Yes – and in many cases, some women choose to have both procedures done at the same time. This is something that Thames Breast Clinic specialises in.

Is having a double mastectomy when I don’t have breast cancer the right thing to do?

That’s a question that only you can answer. Our advice is to consult a breast specialist, check your family history, and talk it over with friends and family.