When is It Best to Have Bilateral Prophylactic Mastectomy?

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.

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.

Long Island Plastic Surgeon
4.6 out of 5 stars 22 reviews

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!


Anureet K. Bajaj, MD
Oklahoma City Plastic Surgeon
5.0 out of 5 stars 18 reviews

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.

Steven Wallach, MD
New York Plastic Surgeon
4.1 out of 5 stars 29 reviews

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.

Sugene Kim, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 76 reviews

Prophylactic Mastectomy

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.

C. Bob Basu, MD, FACS
Houston Plastic Surgeon
4.7 out of 5 stars 210 reviews

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

Peter A. Aldea, MD
Memphis Plastic Surgeon
4.9 out of 5 stars 108 reviews

Indications for bilateral prophylactic mastectomy

I would suggest you see your mother's oncologist for breast cancer genetic testing. Depending on the result, they may support the bilateral mastectomy but might also recommend a hysterectomy and removal of the ovaries. This may seem especially drastic but it is done to save lives. You will need a great support group throughout because when you remove 2 normal breasts, some people may ask you why you did that.

Richard P. Rand, MD, FACS
Seattle Plastic Surgeon
4.8 out of 5 stars 67 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.