The Choice Is Personal
In 2017, a third of people aged 20 to 44 with breast cancer opted for a double mastectomy even if they didn’t have cancer in both of their breasts. This is according to a study published in the Journal of the American Medical Association (JAMA) and represents a drastic increase from 2004, when it was true for only 11% of such patients.
“While there is no survival benefit to removing the uninvolved breast, many patients come to me with their minds already made up that they want a double mastectomy,” says Northwestern Medicine Breast Surgeon Denise Monahan, MD. “I think sometimes this may be related to the overall worry associated with cancer. Often when we talk through all the options and that there is no survival benefit to removing an unaffected breast, many women change their minds.”
If your surgeon gives you the option of keeping the breast while removing the cancer or removing the whole breast, then both options really are acceptable, Dr. Monahan explains.
A common misconception is that reconstructing only one breast will result in a difference in appearance between the two, and many patients value breast symmetry over the preservation of breast tissue, according to Dr. Monahan. But advances in plastic surgery mean symmetry is possible with reconstruction.
Make the Decision That’s Right for You
After a breast cancer diagnosis, the top priority is treating the cancer. Patients face many treatment decisions in the initial visits with their oncologist and breast surgeon. These decisions are highly personal.
Dr. Monahan offers tips about what to contemplate if you are faced with this decision:
- Know your options. Before assuming you need a double mastectomy, talk to your physician about other options, including a single mastectomy or lumpectomy. Remember: You gain no survival benefit from choosing a double mastectomy over a smaller surgery to remove only cancerous tissue isolated to one breast.
- Imagine yourself in five years. Will you be happier after a double mastectomy or single mastectomy? Will reconstructive surgery make you happier than using breast forms?
- Remember that reconstruction is elective. It is an option you can choose, but it is also OK to decide that you do not want reconstruction.
- Think of what your breasts mean to you. Some people see their breasts as a crucial part of their gender identity and sexuality while others do not. Figuring out how your breasts affect your feelings about yourself, your health and your appearance will help you decide which surgical intervention is best for you.
- Realize that you always have options. You are not stuck with the decision you make now. Future options can include revising reconstructive surgery, removing implants or pursuing reconstruction after breast cancer remission.
- Seek support. You are not alone in this decision. Your physicians, nurse navigators, social workers and other members of your care team are great resources. Support groups both online and in person let you connect with people who have already made similar decisions and understand what you’re going through.
“It’s easy to assume the worst when you receive a breast cancer diagnosis, but treatments for breast cancer have improved dramatically over the years,” says Dr. Monahan. “In most cases, breast cancer is highly treatable, but treatment plans should always be individualized.”