What About the Other Breast?

For women considering mastectomy of a breast affected by cancer, the question often comes up as to what should be done with the other breast. Across the United States, about 30% of women undergoing mastectomy elect to have bilateral prophylactic or "total" mastectomy. My practice has a higher percentage of patients – about 60% - choosing to undergo bilateral prophylactic mastectomy to reduce their risk of breast cancer recurrence. Reconstruction surgery is then performed on both breasts.

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There are many arguments that can be made for either having or not having the other breast removed. Some women are so frightened of breast cancer that they want the other breast removed to eliminate the risk of the cancer coming back. For these women, I point out that some patients who get breast cancer also get ovarian cancer and, if they are finished having children, they should also consider having their ovaries removed. If they're comfortable with removing the other breast and their ovaries, I then ask if they would like any other non-essential body parts removed.

Obviously, I have not removed any "extra" body parts, but the point is that each woman needs to make her own decision about the tradeoffs between easing the fear of breast cancer and extending their surgery to remove a now-healthy body part. So, with the risk of life-threatening recurrence, why keep the other breast? Quite simply, it is a healthy organ and can provide a certain amount of sexual pleasure.

Bilateral prophylactic mastectomy is often the right choice for a woman who is BRCA gene positive or who has a family history with multiple close relatives who have had breast cancer. Other candidates for prophylactic mastectomy include women who have had multiple biopsies of their breasts in the past, women who have difficult-to-read mammograms and are always going back for additional views or studies, and women who are going to require extensive adjustment of the healthy breast to achieve a symmetrical result. While I have reconstructed many patients who have elected to have a prophylactic mastectomy of the healthy breast just out of fear of cancer, I consider this a "soft" reason for a prophylactic mastectomy. Nevertheless, it is the woman's choice to remove the healthy breast and I always respect it.

I have the discussion about bilateral prophylactic mastectomy with every patient because any of the abdominal flaps, including DIEP flap or SIEA flap can be performed only one time.

To learn more about breast reconstruction on Long Island and the New York metro area, click here to request a phone consultation from Dr. Keller, a renowned plastic surgeon specializing in reconstructive flap procedures.

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