My grandmother and mother were both diagnosed with breast cancer and passed away from it. I am a 22-year-old, healthy female who is considering a bilateral prophylactic mastectomy. My mom, who lost her battle to cancer in October, was only 40 when she was diagnosed with stage four breast cancer. I want to have the procedure soon but I'm not sure if there is a suggested age. Please clarify this.
When is It Best to Have Bilateral Prophylactic Mastectomy?
Doctor Answers 7
Scheduling a Bilateral Prophylactic Mastectomy
First of all, I am sorry to hear about the loss of your mother and grandmother. With regard to your situation, age is only one factor to consider in deciding when to have bilateral prophylactic mastectomy performed. I would suggest that you see a respected breast surgeon who can help you assess your risk for breast cancer. By seeing a specialist, you can learn about the many different factors involved in this very important decision, such as:
• Did your mother or grandmother have genetic testing for the BRCA gene? Your breast surgeon or a geneticist should look at your whole family history and may want to offer this test to you.
• The specialist also can evaluate other factors that could affect your risk for breast cancer, including whether other family members have had breast cancer and/or ovarian cancer as well as whether you have had any breast biopsies.
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Prophylactic mastectomy and reconstruction
Many women with a strong family history of breast cancer consider having prophylactic mastectomies and reconstruction. For starters, you should consider having a discusion with a genetic counseler to further assess your family history and your need for genetic testing (BRCA testing). Even if you are not a BRCA mutation carrier, you may still be at high risk for breast cancer.
As for timing of the prophylactic mastectomies and reconstruction....most oncologists recommend that you start screening 10 years before the age of your youngest relative with the disease. For you, this would mean that you would need to start screening at age 30. To discuss the optimal timing of your surgeries, you may want to visit with a plastic surgeon and oncologist in addition to the genetic counselor. Good luck!
Bilateral prophylactic mastectomies
The first thing I would suggest is to talk to an oncologist and possibly be tested for the BRCA gene and then after a careful discussion witht the onoclogist you can make a reasonable choice.
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Bilateral prophylactic mastectomy
I am sorry to hear about your mother and grandmother. Given your family history, I understand why you would want bilateral prophylactic mastectomy. You should start getting annual mammogram 10 years prior to the age of your mother's cancer diagnosis. Also, you should see your Ob/Gyn or oncologist to see whether you are a BRCA gene mutation carrier. If you do have BRCA mutation genes, then your prophylactic mastectomy and reconstruction will be covered by insurance. Even if you are not a BRCA carrier, given your high risk family history, your surgery may be covered; however, it will take breast surgeon to be your advocate to get the surgery covered. In terms of timing for prophylactic mastectomy, it will be dependent on your BRCA status as well as when you are ready to undergo that process.
Please visit with a breast surgeon to learn more about your options. Your very strong family history is one reason to consider this procedure. However, you may want to talk to a breast surgeon about BRCA testing to see if you have the breast cancer gene. If indeed you carry the gene, your lifetime risk of breast cancer exceeds 70 percent. Opting for a prophylactic mastectomy is both a scientific (based on evidence and risk) and emotional decision. Learn about your options before making your final decision. Best of luck.
When is it best to have bilateral prophylactic mastectomy?
You should be seen by an oncologist with interest in breast cancer. If you are positive for certain breast risk genes, you should have the operation as soon as possible. When done in this fashion your mastectomies and immediate reconstruction can be planned to follow one another.
Peter A Aldea, MD
Indications for bilateral prophylactic mastectomy
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