The Paradoxes of Prophylactic Mastectomy

Women with BRCA1 and BRCA2 mutation have a very high risk to develop breast cancer during their life. Intensive clinical surveillance does not prevent the cancer development. It only allows an earlier detection of the disease. Therefore, preventive bilateral breast removal, named prophylactic mastectomy, is an accepted radical choice since it is the only effective way against cancer development. However this procedure generates some paradoxes of the modern senology. The woman‘s choice is usually validated by a tumor board meeting where personal preferences are hardly taken into account. To avoid the emergence of the cancer disease, the preventive surgery may create a new form of disease to a variable extent: aesthetic sequelae. The curative surgical procedure for invasive breast cancer is often less physically demanding for patients than a bilateral mastectomy associated with a double breast reconstruction, especially if the reconstruction is performed using free flaps. After the prophylactic surgery, a clinical and radiological follow-up has to be established to detect residual cancer risk and to prevent potential breast implant complications.Breast prophylactic mastectomy is today an extreme but justified preventive option for some genetically predisposed patients. Thanks to medical advances, this practice might be replaced one day by more appropriate and less aggressive means.