Risk-reducing breast surgery

Risk-reducing breast surgery is only suitable for a small number of women, or people assigned female at birth, who have a high risk of getting breast cancer. You may be offered risk-reducing breast surgery if one or both of the following are true:

You may be offered risk-reducing breast surgery if you have:

• You have a strong strong family history of breast cancer or ovarian cancer, or both.
• You have had a positive test for the gene mutations (changes) linked to an increased risk of breast cancer. These include BRCA1, BRCA2, TP53, PTEN, ATM, PALB2, CHEK2, STK11 and CDH1.

Your doctor, a clinical geneticist or a genetic counsellor can talk to you about this.

Risk-reducing breast surgery may also be an option if you have had breast cancer and have a high risk of developing another breast cancer.

You will have a pre-operative assessment before your operation. This will involve some tests to check your general health and fitness.

Your surgeon will talk to you about the different types of risk-reducing breast surgery and their risks and benefits. These are the main types of operation.

This operation removes:

• the nipples
• the darker circles of skin around the nipples (areolas)
• other tissue that makes up the breasts.

The surgeon will leave the skin that covers the breasts. This is used to cover your reconstructed breasts.

It may be possible to keep your nipples if you have risk-reducing breast surgery. This is usually if you are having breast reconstruction surgery at the same time as the mastectomy. This called having an immediate reconstruction.

A nipple-sparing mastectomy removes almost all the breast tissue but leaves the:

• nipple
• areola
• breast skin.

These will be used to cover the reconstructed breasts. The nipple is then removed and reattached to the reconstructed breast. This can be done either with or without the areola. Or you can have a nipple reconstruction. This is where the nipple shape is made from the remaining skin and attached to the reconstructed breast.

If you are having a nipple-sparing breast reconstruction with implants, it can sometimes be difficult to achieve an ideal nipple position. The nipples may be too low. There can also be a slight increase in wound-healing problems if some breast skin is removed at the same time.

You can have further surgery to correct the nipple position. If you have naturally larger breasts, the surgeon may recommend surgery to lift your breasts before a mastectomy. This means some skin can be removed and the position of the nipple changed to a more natural position before the nipple-sparing mastectomy.

This operation helps make sure the nipple is in the right position when you have your operation to remove and reconstruct the breasts.

This operation is done if you choose not to have breast reconstruction. The surgeon removes:

• the nipples
• the areolas
• the breast tissue
• about half of the skin covering the breasts.

The skin that remains is used to cover the chest.

Like a simple mastectomy, this operation involves removing the breast tissue. But the surgeon uses the skin and fat, usually removed during a mastectomy, to form a small breast shape.

For some, it may look better than a simple mastectomy. It can also help to keep a breast prosthesis in position within a bra. A breast prosthesis is an artificial breast form that can be used to replace all or part of the breast.

Goldilocks mastectomy is not suitable for everyone. It will depend on the size of your breasts before surgery.

If you have breast reconstruction, there are different types. The new breast shape can be made using a breast implant, or tissue taken from another part of your body, also known as flap reconstruction. A combination of both these types is sometimes used.

You will have a pre-operative assessment before your operation. This will involve having some tests to check your general health and fitness.

You may be given information about what to bring into hospital, such as:

• comfortable clothes and nightwear with buttons down the front
• a supportive bra.

If you smoke, your surgeon will talk to you about giving up smoking before surgery. If you have breast reconstruction, you are more likely to develop problems after breast reconstruction surgery if you smoke. Your hospital and GP will give you help and support to stop smoking.

Your breast care nurse will give you advice and support on what to expect after breast reconstruction. If it is needed, the ward nurses can arrange for district nurses to visit you at home and look at any wounds and dressings .

You may have other operations or procedures you such as, having a nipple reconstruction or a procedure called lipomodelling (fat transfer). This may be used to smooth out any uneven areas of the new breast shape.

You will not need to have any further screening tests after risk-reducing breast surgery. But you should still check your breast area regularly. There will be a small amount of breast tissue remaining.

Having breast surgery may affect your sex life and the way you think and feel about your body (body image).

Breast reconstruction creates new breast shapes. But the sensations in the breasts and nipples will not be the same as before.

If you have a partner, there may be a period of adjustment for you both. Talking to each other and sharing your feelings and fears can help you overcome most worries with time.

If you are having sexual difficulties that are not improving, help is available. You can get sex counselling through Relate or the College of Sexual and Relationship Therapists (COSRT). Or ask your doctor to refer you to a sex counsellor.

We have more information about recovering after breast reconstruction surgery.