La preventive mastectomy is a surgical procedure intended to greatly reduce the risk of breast cancer. This operation consists of the removal of both breasts and is accompanied by breast reconstruction generally carried out during the same operation. It is almost exclusively offered to women with mutations of a BRCA1 or BRCA2 genes, and therefore have a high probability of contracting cancer.

During the operation, the surgeon tries to remove all of the breast tissue, which is a favorable site for the development of tumors, but the morphology limits total ablation, so that there is still a residual risk of cancer. One study showed that the likelihood was reduced by at least 90% ^[1]. It therefore does not confer absolute protection (and cannot prevent the occurrence of cancer in other organs), but allows a significant reduction in risk. A question then arises: can we reasonably mutilate our body to avoid cancer that we may never have? For the National Cancer Institute, the answer is clear: “ Prophylactic bilateral mastectomy remains the most effective measure to prevent the risk of breast cancer in an unaffected woman with a BRCA1 / 2 mutation. However, the intervention must remain a proposal and not a recommendation. »A proposal that attracts neither the French nor the Quebec women concerned: only 5% of them opt for this choice against nearly 30% in the United States or the Netherlands. Probably for cultural reasons, the patients are moving more towards a radiological follow-up, a strict surveillance.

What benefits?

In addition to the significant reduction in the risk of cancer, preventive mastectomy often brings relief to predisposed women. Mandatory close monitoring examinations (MRI, mammograms, biopsies, ultrasounds) and the prospect of probably having to face cancer one day lead to significant anxiety disorders. The operation can then be experienced as a real relief from anxiety.

In addition, preventive breast removal is 100% covered by Social Security. It is obviously only offered to women prone to an increased risk of breast cancer and carried out in certain very specific cases. All check-ups and detection tests are also reimbursed in the event of a high genetic risk. The operation should not be scary: it lasts about four hours, and the patient can usually leave a few days later.

And the risks?

Of course, any transaction involves risks. There are certainly those inherent in anesthesia (allergies, cardiac arrests), but here the risks are more on the psychological level. Mastectomy can have consequences on the relationship with the body and self-esteem, the breast being the deep symbol of female identity. However, despite the progress of reconstructive surgery, reconstructed breasts will not be perfect: complete insensitivity of the breast, feeling of hardness in the breast reconstructed by implant, visible scars, possible complications, etc.

For all these reasons, it is essential to learn about the techniques, the aesthetic results, the risks and the expected benefits. It is also advisable to discuss it with relatives and health professionals (doctors, psychologist, surgeon). The decision to have the operation is an individual choice that requires careful consideration: in France, the specialized teams ask to respect a period of at least 4 months after receiving the information.

Sources : Sources : JAMA 2010;304(9):967-975. doi:10.1001/jama.2010.1237« Association of Risk-Reducing Surgery in BRCA1 or BRCA2 Mutation Carriers With Cancer Risk and Mortality »