Preventive mastectomy, which the whole world once made a fuss about because Angelina Jolie made it for herself, is a very reliable way to reduce the risk of developing breast cancer. In developed countries, this procedure is widespread especially for women who carry out the mutations in the BRCA1 or BRCA2 genes (initially these genes are responsible for the repair of damaged cells and protect our body from tumors), but it can also be performed in women who are not carriers of harmful mutations. However, discussions are still ongoing in medical circles on how appropriate this surgery is in this case. It is worth noting that women who have a mutation have a high risk of developing any ‘’ female ’’ cancer. That is why, in the presence of a mutation, it is advised to remove both the mammary glands, and the ovaries.
How is a preventive mastectomy performed?
The operation is carried out not just by a plastic surgeon, but by a reconstructive surgeon, this is a separate specialization, which in Europe is considered a rank higher than the category of an ordinary plastic surgeon. The result and appearance will depend on the qualifications of the surgeon. During the operation, the surgeon will have to remove as many breast tissues as possible so as not to leave tissue that could give rise to a further tumor. The operation lasts two to three hours, depending on the volume of the chest and the desired result. Many women take the opportunity and do a breast lift or augmentation, choosing larger implants than the original breast size. You can also change the shape. With high-quality surgery, the breast looks very natural.
You can fill the breast with implants, nowadays in France they do not use macro-texture implants, only micro and medium texture implants without a shell. They also use fat, lipofilling or implants and fat for the most beautiful and natural result. The operation is always carried out under general anesthesia, in France there is a special safety procedure related to anesthesia, which must be carried out by law 48 hours before the surgery.
How effective is preventive mastectomy?
Firstly, the result depends on the quality of the operation, since the surgeon has the task of removing the tissue as much as possible, but even with a very ’clean’ ’mastectomy, the probability of preventing cancer is about 90 percent. (1. JAMA 2010; 304 (9): 967-975. Doi: 10.1001 / jama.2010.1237 “Association of Risk-Reducing Surgery in BRCA1 or BRCA2 Mutation Carriers With Cancer Risk and Mortality”) Thus, preventive mastectomy is not one hundred percent protection against breast cancer, however, is a significant factor that can greatly reduce the risk of disease.
The question is simple: is it worth lying down under the surgeon’s knife and consciously “shred” yourself without having a 100% guarantee that there is no risk of getting breast cancer?
The Oncology Institute unequivocally recommends surgery in the presence of a mutation. “Preventive bilateral mastectomy is the most effective way to prevent breast cancer in women with mutations in BRCA1 / 2, but this decision should be voluntary and not a recommendation” , this is the position of the national cancer institution. In France and Quebec, the percentage of women who decide to have this surgery is quite low relative to the percentage of women who decide to have surgery in the Netherlands or in the United States. The former prefer active observation with regular diagnosis. On the photo, the first Frenchwoman who underwent a total preventive mastectomy in 2008.
Pros of prophylactic mastectomy?
First of all, this is a significant reduction in the risk of getting breast cancer. Regular and mandatory tests, such as mammography, a scanner, ultrasound and biopsy and the prospect of getting a positive result in one day, significantly traumatize the psyche of women. The stress a woman lives in can cause health problems. After the operation, a significant psychological relief comes.
What are the risks of preventive mastectomy?
Previously, when a preventive mastectomy was performed in two operations and the results of breast restoration were clearly not very natural, there were much more risks. Basically, all the risks are associated with the operation itself and anesthesia, this is a classic set of operational risks, such as infection, complications from anesthesia, capsular contracture of implants, rejection of implants. All these risks can be significantly reduced, but not completely removed. As with reduction mammoplasty and breast lift, there is a risk that a woman will not be able to breastfeed.
The main problem in the presence of a mutation in the genes is a bilateral preventive ovariotomy, which is recommended to be carried out together with a mastectomy, since the presence of this mutation can cause aggressive forms of ovarian cancer. When the ovaries are removed, a hormonal imbalance occurs in the woman's body and then hormones will have to be taken.
Should a preventive mastectomy be done if there is no BRCA 1 & 2 mutation?
Breast cancer is the first cancer among women. On average, 1 woman out of 10 gets sick. Risks increase if you lead an unhealthy lifestyle. However, preventive mastectomy does not make it possible to lead an unhealthy life, since smoking, abuse of carbohydrates and alcohol can cause oncology of other organs. Scientists and doctors are controversial regarding preventive mastectomy in women who do not have mutations in the genes. Thus, the decision remains with the woman herself. If a woman is experiencing a lot and bad thoughts interfere with living quietly and affect psychological health, perhaps the operation will be the right decision. However, if there are no obsessions and this is nothing more than a concern, a healthy lifestyle and regular examination will be enough.
Prices for preventive mastectomy in Europe vary, in France such an operation costs from 7,000 to 10,000 euros, the final cost depends on the initial breast volume and the patient's preferences with regards to recovery.