Fight Breast Cancer.

Fight Breast Cancer.

Scottsdale – A recent report detailed on Fox News reports that more women undergoing mastectomy for breast cancer are choosing to have the unaffected breast removed at the same time in an effort to reduce the risks of recurrence. The original report which appears in the medical journal Cancer, was formulated using data from New York State hospitals between 1995 and 2005. During that time the prevalence of preventive mastectomy in women with a history of cancer in one breast more than doubled.

While this is an impressive trend, the study showed that just over 4 percent of the women choose the prophylactic option in 2005. That is significant, however, because in 1995 only about 2 percent of women diagnosed with breast cancer chose prophylactic mastectomy.

The senior investigator on the study, Dr. Stephen Edge, said that a controversial issue with prophylactic mastectomy is that there is no evidence that removing the unaffected breast improves long-term survival. It is believed that prophylactic mastectomy likely reduces the chances of breast cancer developing in the second breast.

Dr. Edge did note that among women who are not at risk for genetic cancer (95 percent of all breast cancer patients) the odds of developing cancer in the second breast are between 10 and 20 percent over 20 to 30 years. This is important because many patients can survive breast cancer for that length of time with the newer treatment regimens currently available.

“Women need to be carefully counseled on the issues of the risks of developing a second cancer, and the largely minimal or no impact this may have on their survival,” Edge said. Later he added that, “The large majority of breast cancers are detected early and effectively treated.” The article concluded by saying that women need to consider the uncertain long-term benefits of prophylactic mastectomy and the risk of complications including bleeding, infection and nerve damage.

As a plastic surgeon, I have seen the number of bilateral mastectomies increase over the last few years. The underlying factors are complex, however, many of these patients decide to proceed with breast reconstruction after mastectomy. It is well known that much better symmetry is achieved when both breast are reconstructed than when trying to match a reconstructed breast to a non-reconstructed one.  As the options for reconstruction of the breast have improved significantly since 1995 it makes sense to see more patients choosing these techniques.  In particular, the autologous techniques which use the person’s own tissue can create some of the most-natural looking breast reconstructions available.

Advances in using these techniques have lowered the risks for may patients. Since only 4% of the study population had the prophylactic mastectomy, it makes me believe that plastic surgery education and the reconstructive options are not as widely known.