Whether a woman is facing the decision to have breast surgery as a treatment option for cancer or she is being proactive and having a preventive procedure done to reduce the risk of ever having cancer, the decision is not an easy one. Surgery can be a frightening experience for some people, and rightfully so. Although surgery is designed to physically remove unhealthy tissue containing cancer, it is also an accepted option to remove healthy tissue to prevent cancer, especially for someone who is at an increased risk. However, surgery comes with risks and the potential for complications or unexpected outcomes. You should have a detailed conversation with your surgeon to discuss all the pros and cons of surgery to help you better understand a potentially difficult and frightening experience.

In the case of preventive bilateral mastectomy, by which the majority of a woman’s healthy breast tissue (sometimes including the nipple) is removed surgically, the goal is to reduce the chance of future breast cancer formation as much as possible. However, this is not a 100% risk reduction. It is estimated that 90-95% of breast tissue is removed, but about 5-10% can still be present after surgery. This procedure reduces the risk of developing breast cancer by 90-95%, but careful screening is still required for the remaining 5-10% chance of chest wall cancer.

A woman’s breasts are unique to her. How a woman feels about her breasts and her body is personal. For some women, breasts may represent nurturing or motherhood. For others, they may be part of her identity and what makes her feel feminine. For centuries, after a woman had a mastectomy, she was left flat and had limited options to achieve a breast shape. Over the years, however, we have been able to reconstruct a breast shape out of a woman’s own skin, muscle, and body fat with the aid of implants or flaps. These reconstructive surgeries, performed by a plastic surgeon, are the best that medicine can offer a woman after her breasts are removed, but they are by no means perfect. Reconstructed breasts will never be like your original breasts. They will not look, move, or even feel like them. Some women may have healing issues leading to scarring or multiple surgeries. For some types of reconstruction, it can take 6 months to a year before the reconstruction is finally complete. Unlike after a breast augmentation, (aka boob job), a woman undergoing reconstruction after mastectomy does not wake up from surgery with new breasts. Following a mastectomy, a woman can be essentially flat chested. Some women may have expanders (inflatable breast implants) behind the muscle that will gradually be filled with saline (salt-water solution) over weeks to get to the desired size. This can be emotionally and physically traumatic for someone. When preparing to undergo surgery, be sure to look at before, during, and after photos of the procedures so you know what to expect. Some women keep their own nipples for a more natural look, but this comes with a slightly higher risk of cancer development within the nipple in the future.

If you are considering preventive bilateral mastectomies (with or without reconstruction) to reduce your risk of developing breast cancer in the future, it is important that you discuss and weigh the risks and benefits of your options with your surgeons.