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Some women with a very high risk of breast cancer might choose preventive surgery to remove their breasts or ovaries. This is called prophylactic mastectomy (breast) or prophylactic oophorectomy (ovary). Prophylactic means something used to prevent disease.

Should I consider surgery to lower my risk of breast cancer?

You might consider preventive surgery if you:

• Have a gene change (mutation) in a high-risk gene, such as BRCA1, BRCA2, or another gene that increases breast cancer risk, found by genetic testing
• Have a strong family history of breast cancer, such as several close relatives with breast cancer or 1 or more relatives diagnosed with breast cancer at a young age
• Had radiation therapy to the chest before age 30
• Have cancer now, or have had cancer before, in one breast, especially if you also have a strong family history

When considering surgery, other factors such as overall health, age, and how surgery may affect you are important. Like any surgery, a mastectomy or oophorectomy can have risks and side effects. Some of these could affect your daily life. Because of this, preventive surgery is not usually a good option if you are at average or slightly increased risk of breast cancer. It is not usually a good option for people who have other health issues that make surgery riskier.

Prophylactic mastectomy

A prophylactic mastectomy is surgery to remove one or both breasts. This lowers the risk of breast cancer. Different types of mastectomies might be options.

A prophylactic mastectomy can lower breast cancer risk by 90% or more. However, it doesn’t guarantee that you will not get breast cancer. This is because it's not possible to remove all breast cells, even with a mastectomy. The breast cells that remain might still become cancer.

A prophylactic mastectomy might be considered in two main situations.

For women at very high risk of breast cancer

For those with very high risk of breast cancer, removing both breasts before cancer is diagnosed can greatly reduce the risk of breast cancer. This is known as a bilateral prophylactic mastectomy. While this reduces the risk, it does not completely eliminate it.

There’s no way to know if someone will benefit from this surgery.

Most women with a BRCA1 or BRCA2 gene changes will develop breast cancer at some point. Having a prophylactic mastectomy before the cancer develops might add many years to their lives. But not everyone with BRCA1 or BRCA2 gene changes develops breast cancer. For some, the surgery might not have been helpful.

Women with other high-risk breast cancer gene changes or genetic syndromes should talk to their healthcare team about risk-reducing surgery. These include those with TP53, CDH1, PALB2, PTEN, and STK11 gene changes.

There might be benefits from the surgery, such as peace of mind. Yet, it’s important to consider the physical and emotional side effects of surgery.

For women already diagnosed with breast cancer

Some women who have been diagnosed with breast cancer choose to have the other breast removed at the same time they remove the breast with cancer. This operation is known as a contralateral prophylactic mastectomy, or CPM. It can help lower their risk of developing a second breast cancer.

This is more likely to be a good option for women who also have other factors that increase their risk of getting another breast cancer. They may have risk factors such as a BRCA1 or BRCA2 gene change or a strong family history of breast cancer.

But for women who don't have a family history or other risk factors for breast cancer, the benefit of CPM is less clear. Having breast cancer in one breast can raise your risk of getting cancer in the other breast. But this risk is still usually low, and many people overestimate this risk. Although CPM lowers the risk of getting cancer in the other breast, it does not increase most people’s chances of living longer. This procedure may also increase the risk of surgical complications, which could delay other planned cancer treatments, such as radiation or chemotherapy.

Before having this type of surgery, talk with a member of your cancer care team? or a genetic counselor. They can help you understand how much you might benefit from surgery and the likelihood of risks and side effects. You might also want to get a second medical opinion and talk to others who have had this surgery before deciding whether it’s right for you.

Prophylactic oophorectomy

A prophylactic oophorectomy is surgery to remove the ovaries. This lowers the risk of ovarian cancer. Women with a BRCA1 or BRCA2 mutation have a high risk of developing both breast cancer and ovarian cancer.

Most doctors recommend that women with a BRCA1 or BRCA2 mutation have surgery to remove their ovaries and usually the attached fallopian tubes once they are done having children. 

While this surgery greatly reduces the risk of ovarian cancer, some studies have suggested it might lower the risk of breast cancer as well. Although not all studies have found this. Some people at high risk choose to have this surgery done along with a prophylactic mastectomy.

Removing the ovaries causes you to go into menopause. This can lead to symptoms such as hot flashes, trouble sleeping, vaginal dryness, loss of bone density, and mood changes.

Talk to your healthcare team so that you know about the possible benefits, risks, and side effects of this type of surgery. You might also want to talk to others who have had this surgery before deciding if it’s right for you.

Other options to reduce breast cancer risk

If you’re concerned about your breast cancer risk, talk to your healthcare provider. They can help you understand your risk based on your age, family history, and other factors. If you are at increased risk, you might consider taking medicines that can help lower your risk. Your healthcare provider might also suggest you have more frequent screening or additional screening for breast cancer. This might include starting screening at a younger age or having other tests in addition to mammography.

Other things can also help lower your risk of breast cancer. Take part in regular physical activity, stay at a healthy weight, and limit or do not drink alcohol.

More resources

Learn more information about breast cancer risk.