Reconstruction R6
Prophylactic mastectomy
Removing the breast gland in a high-risk patient, before a lesion appears, and rebuilding the breast in the same operation. A decision taken by a board.
- Anaesthesia
- General
- Decision
- Multidisciplinary board
- Scar
- 7 to 8 cm if areola removed
- Healing
- 21 days
Figures confirmed by the surgeon; they vary from case to case and are specified in consultation.
The essentials
The four questions that come up
- What does the operation involve?
- Performing a mastectomy in a high-risk patient, often with a history of cancer in the other breast. The gland is removed before a lesion appears, and the breast is rebuilt in the same operation.
- Who decides the indication?
- It is decided according to several factors and must be validated by a multidisciplinary breast board. It is a delicate decision: your surgeon and your oncologist will advise you.
- Is the areola preserved?
- The nipple-areola complex is generally removed together with the gland, but preserved in some cases. Where the areola is removed, the scar is central and measures 7 to 8 cm.
- How is the breast rebuilt?
- With an anatomical breast implant in a submuscular position, placed in the same operation. The result can be refined by secondary lipomodelling at a later stage.
Removing the gland before the lesion
This operation consists of performing a mastectomy in a high-risk patient, often with a history of cancer in the other breast.
It does not treat a lesion: it prevents one from appearing. That is what sets it apart from every other operation described on this site, and what explains the weight given to the decision.
High risk covers several situations. The most often cited is carrying a germline BRCA 1 or BRCA 2 mutation, identified through a cancer genetics consultation. To that are added a history of cancer in the other breast, and family history. None of these amounts to an indication on its own: it is for the board to weigh the whole picture.
A decision validated collegially
It must be decided according to several factors and validated by a multidisciplinary breast board.
The question also arises, sometimes, during a reconstruction: management of the opposite breast may prompt a discussion about considering instead a prophylactic mastectomy with immediate reconstruction, in the light of the patient’s history, age and genetic risk factors.
This is a delicate decision to take. Your surgeon and your oncologist will be able to advise you. The plastic surgery consultation comes within that framework, not in its place.
What the operation removes
The nipple-areola complex is generally removed together with the gland, but it is preserved in some cases.
Where the areola is removed, the scar is central and measures 7 to 8 cm. Its reconstruction can be carried out later, about three months after the breast mound has been rebuilt, by grafting half of the opposite nipple and by medical dermopigmentation.
Reconstruction, in the same operation
Reconstruction is provided by an anatomical breast implant, in a submuscular position.
Prophylactic mastectomies benefit from immediate reconstruction: the patient never experiences the period without a breast. Results can be refined by secondary lipomodelling at a later stage, which improves the natural feel, the softness and the concealment of the implant.
Recovery
Recovery is generally straightforward, with healing in 21 days.
Follow-up then joins that of any implant reconstruction: the skin relaxes over a few months, and secondary lipomodelling can be offered from three months onwards.
Frequently asked questions
What patients ask
These answers reflect the content written and validated by the surgeon. Each one is written to stand alone, question by question.
What is a prophylactic mastectomy?
Does a BRCA 1 or BRCA 2 mutation lead to this operation?
Can the nipple be preserved?
Is reconstruction done at the same time?
How long does healing take?
Meet us
Consultation
A first consultation is there to understand your request and tell you what is possible — including when the answer is that it is better to do nothing.
Clinique Esthétique Ferrère
16 ter rue Ferrère
33000 Bordeaux
In cosmetic surgery, French law requires a detailed written quote and a cooling-off period of at least fifteen days between the consultation and the operation. No deposit may be requested during that period. Two consultations are required before any operation.