Prophylactic Mastectomy And Benefits Of Removing Both Breasts

In this clip Dr. Harness explains the benefits to removing both breasts in what is called a prophylactic mastectomy.


Jay K. Harness, MD, FACS: Just recently I was asked a question about, “Doctor, what’s the role in removing my healthy breast if I have a cancer on one side and want the other side removed? Is there a benefit if I do that? Am I going to have a better survival?”

Well let’s start at the beginning – first of all what is a prophylactic mastectomy – that’s the medical term. Prophylactic means preventative upfront; mastectomy of course is removal of the breast.

I particularly get this question from younger patients because often they say to me, “I never want to have to deal with breast cancer again”, and this whole issue of the role of removing the healthy other breast has actually been the study of several series that have been published in the medical literature.

A really good one was last year in early 2010 that came from the MD Anderson Hospital in Houston, Texas. They worked at a large, large national database and then drilled down on the data to see if that question could be asked – ‘is there a survival benefit for removing the other healthy breast?’

The answer is yes but the numbers are very, very small. Where that benefit is seen is in women who are under age 50, when they are originally diagnosed, they have stage-1 or stage-2 breast cancer, and importantly, their cancer is estrogen-receptor negative, which you recall, tends to be a more aggressive kind of breast cancer. The benefit was quite small. It was 4.8% improvement in survival.

Now when we look at the big picture of removing the other healthy breast there’s been a real trend in the United States and now somewhat in Europe over particularly the past decade where there’s been an increasing incidents and increasing use of removing the other healthy breast. These numbers have more than doubled in some reported series.

The main indications for prophylactic mastectomy are in patients who are known to be gene-positive, patients who are indicated maybe quite young at the time of their initial diagnosis and have more aggressive kind of breast cancer – the estrogen-receptor type, and those who have a really high incidence of breast cancer in their mom or sisters but are actually gene-negative.

This is a personal, individual decision that patients need to make. They need to be in the hands of a multidisciplinary team. They need to be in the hands of breast and plastic surgeons who are committed to the best kinds of reconstruction, following mastectomy. My own bias about that is that nipple-sparing mastectomy is one of the really great ways to go.

So hopefully that gives you sort of a big picture answer to a question that I am asked very frequently.

Dr. Jay K. Harness is a board certified surgeon currently treating patients at St. Joesph Hospital in Orange, CA. Dr. Harness specializes in complete breast health, breast cancer surgery, oncoplastic reconstruction, genetic screening, management of breast health issues, risk assessment and counseling. Dr. Harness is the medical director for Breast Cancer, and guides this first ever social media show’s information by drawing on his former leadership experience as the President of the American Society of Breast Surgeons and Breast Surgery International. Dr. Harness graduated from the University of Michigan, Ann Arbor in 1969 and spent time early on in his career at the University of Michigan Medical Center.

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