PROPHYLACTIC OR PREVENTATIVE MASTECTOMY

A prophylactic mastectomy can reduce the risk of breast cancer development by up to 90%.

A prophylactic mastectomy is a surgery done to remove one or both breasts as a precautionary measure to reduce the risk of developing breast cancer.

Indications:

A prophylactic mastectomy is a voluntary surgery done for those who are high risk of developing breast cancer. These are commonly women who:

  • have a strong family history of breast cancer
  • are positive for a BRCA1, BRCA2, PALB2, CDH1, PTEN, or TP53 gene mutation
  • have been exposed to various factors that increase one's chances of developing breast cancer
1WHAT DOES SURGERY ENTAIL?
Those who choose to have this preventative surgery have the option of three types of prophylactic mastectomies: a simple or total mastectomy, a skin-sparing mastectomy or a nipple-sparing mastectomy. These involve the removal of most of the breast tissue while sparing the skin to allow for a reconstructed breast, which can be done immediately.

In terms of surgery, a mastectomy surgery is done under general anaesthesia. It usually takes 1-2 hours to complete, but if reconstruction is being done immediately after, it may take longer.

Depending on the type of mastectomy, a variety of incisions may be made. For a total mastectomy an oval-shaped incision is made around the nipple and through the breast to remove breast tissue, whereas a skin or nipple sparing mastectomy will involve multiple smaller incisions.

The breast tissue is then separated from the skin and from the muscular chest wall beneath it. The entire breast tissue is then removed.

If immediate breast reconstruction is part of your surgery plan, the reconstruction will begin. Finally, Dr van Schalkwyk will check for areas where bleeding is extensive and insert drainage tubes which will collect excess fluid that accumulates, before closing the incisions. Your surgeon will cover your incisions and wrap your chest for support during recovery.
2WHAT CAN I EXPECT FOR RECOVERY?
A prophylactic mastectomy is a serious procedure. It is essential that patients understand the physical and emotional effects and the recovery process thereafter. Dr van Schalkwyk will carefully explain all that you can expect for post-operative recovery prior to surgery. It is important to know what to expect.

After the surgery, you will remain in the hospital for about three days for observation before you can be taken home. Be sure to pack the essentials that will be needed, including special bras (which your surgeon will discuss with you). You will need someone to drive you home and look after you. You will be given instructions regarding pain management, caring for the drains and showering. You should ask friends and family for help while you recover. Rest is an important part of recovery.

Understand that a mastectomy is a life-changing surgery; you should expect to feel emotional. It is normal to feel grief, anger, sadness, and fear after this type of procedure and be sure to ask for support when needed.


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