Why Have a Bilateral Mastectomy?

We continue to see a worrisome trend across the country in women diagnosed with early-stage breast cancer. Some of these women are choosing to have bilateral mastectomies, despite the fact that they have small tumors that could be successfully resected, by means of a lumpectomy, to get rid of the cancer.

Granted, radiation will be needed after the resection, but that is well tolerated and doesn’t make the patient sick. And besides, doing bilateral mastectomies instead of a lumpectomy has no bearing on whether a woman needs chemo or not. If she needs chemo, then she needs chemo. Period.

What do women say about bilateral mastectomies?

Recently, I have been asking a few patients how they reached their decision for a bilateral mastectomy. Here are some of their responses:

  • “I don’t want to ever have to have a mammogram again. I’ve had mammogram after mammogram and biopsy after biopsy. I’m done.”
  • “I want my breasts to still have good symmetry. Having a bilateral mastectomy with reconstruction enables me to achieve that look.”
  • “I tested negative for the breast-cancer genes but I still worry. My sister and mother have also had breast cancer. I don’t want to have to think about this anymore.”
  • “I’ve had droopy breasts for years. I can upgrade now and get a perky pair. It’ll be a silver lining for me in a scary medical crisis.”

A risk still exists despite mastectomies

Though it is true that doing bilateral mastectomies dramatically reduces the risk of getting breast cancer locally again (that is, within the breast area), it is not a zero-percent risk. Actually, there remains a 1 percent to 2 percent risk—small, but still there.

This risk remains because it’s impossible to remove every single breast cell. Also, the risk of getting breast cancer recurrence in a distant organ remains the same, no matter what surgery is done. If a rogue cell has left the breast and traveled elsewhere, and sits dormant until a later date, it can then wake up and proliferate—and this can happen whether there is breast tissue resting on a woman’s chest or not.

Breast sensation is lost

So what would you do if facing a diagnosis of early-stage breast cancer? Remember that breast sensation is lost in general with a bilateral mastectomy. Not to mention the ordeal of surgery and healing after such a major surgery. Would you choose a bilateral mastectomy, too?  Remember to consider all the aspects of this surgery carefully with your healthcare team.


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