Mastectomy: what you need to know

Mastectomy is a surgical procedure of total or partial removal of the breast in cases of breast cancer diagnosis. It is referred to as double mastectomy if surgery is required on both breasts. Instead, preventive mastectomy is used on women who have a high risk of developing this neoplasm because, for example, they carry mutations in the BRCA1 and BRCA2 genes.

The genes involved in the occurrence of breast cancer, in fact, are particularly two: BRCA1 and BRCA2 (BReast CAncer genes). Mutations in these genes result in an increased risk of developing various types of neoplasms:

• to breast and ovary
• to the tubes
• prostate (men)
• melanoma 1 .

The Orphanet rare genetic disease database

The rare genetic disease database Orphanet 2 estimates that about 1 to 5 out of 10 women.000 are carriers of the mutated forms of BRCA1 and BRCA2. This condition results in a lifetime risk rate of getting breast cancer of 50-80%, compared to 12-13% for women who do not carry mutations 1 . Preventive mastectomy is a surgery that many women who carry a genetic mutation undergo, and who therefore have a high risk of developing an early and aggressive form of breast cancer 1 .

In the past decade, it is estimated that in the United States, the number of women who have undergone preventive mastectomy has tripled. For this reason, the National Comprehensive Cancer Network (NCCN), a public body for the development of indications and guidelines, has seen fit to point out that since this is a heavy operation both physically and psychologically, there need to be boundaries so that it is an informed and important choice 1 .

Undergoing a preventive mastectomy is an individual choice

Undergoing a preventive mastectomy is an individual choice, but one that must be made with the help of a team of physicians (including the senologist, plastic surgeon, and geneticist), who will thoroughly evaluate familiarity and specific individual characteristics 1 .

There are alternatives to preventive mastectomy for women carrying a BRCA1 and BRCA2 gene mutation, such as:

• Constant screening, through ultrasound scans, mammograms, and MRIs every year starting at age 30
• The use of anti-estrogen drugs, but these can have side effects
• removal of the ovaries, which may have the same effect as antiestrogen drugs, but is usually recommended for older women
• lifestyle change, as proper diet, physical activity and a healthy lifestyle can be excellent preventive factors.

To have the maximum beneficial effect and reduce the risk of developing breast cancer, it would be advisable to combine different prevention strategies 1 .

Preventive mastectomy does not reduce the risk of getting cancer to zero

Preventive mastectomy does not reduce the risk of getting breast cancer to zero in women carrying mutations of the BRCA1 and BRCA2 genes, but it reduces it by up to 5% 1 .

Preventive mastectomy surgery can also be contralateral, that is, the healthy breast is removed after the other has been affected by cancer. The percentage of women, who have had breast cancer in only one breast, of being able to develop the same neoplasm in the other breast is between 2 and 8 percent. Although the effectiveness of this operation is not always proven, many of them decide to undergo contralateral preventive mastectomy anyway 3 .

Resorting to breast reconstruction surgery

After a mastectomy, when possible, breast reconstruction surgery can be performed, which can occur either at the same time as the mastectomy or at a later date. Breast reconstruction can be proposed in two ways: using permanent or temporary implants, or using muscle or skin tissue from the same patient 4 . There can be side effects, such as implant rejection or contracture, if we are talking about the use of implants, or weakening of the anterior abdominal wall and navel deviation, if muscle tissue is used 4 .

Mutations in the BRCA1 and BRCA2 genes can be detected through specific genetic tests, such as the SourceBRCA test: the entire genetic sequence is analyzed from a blood sample for mutations. The Test is Recommended for Women Who Have A History of Family Wit Breast and/Or Ovarian Cancer.