Prophylactic mastectomy

Prophylactic mastectomy in Munich and Starnberg with private lecturer Dr Max Geishauser

Fewer scars. More feeling. The more beautiful breast.

Preventive breast removal and simultaneous breast reconstruction in one operation for patients with a family risk of breast cancer. Are you interested in prophylactic mastectomy? Let the experienced plastic surgeon PD Dr. Max Geishauser advise you.

Familial breast cancer risk and preventive surgery

Women with a family history of breast cancer have always wondered whether it might make sense to remove the breast before breast cancer develops. For several years now, a hereditary risk has also been detectable. This means that the risk can be better assessed.

Prophylactic mastectomy should then often be considered. In this case, skin sparing mastectomy and breast reconstruction can be performed in one operation.

Prophylactic mastectomy – How can an increased risk be detected?

Genetic testing can already detect a number of genes whose carriers have a significantly increased risk of breast cancer.

The most important genes are BRCA 1 and BRCA 2, BRCA 3 and others such as ATM, p53 and CHEK. The risk of a woman with a BRCA1 or BRCA2 mutation developing breast cancer during her lifetime is about 50 to 80 percent. If a carrier of the gene mutation has already developed breast cancer in one breast, the risk of developing breast cancer in the other breast is about 60 percent.

According to the current state of science, prophylactic mastectomy can reduce the probability of developing breast cancer by 90-95%. This must always be preceded by special genetic counselling.

How can a prophylactic mastectomy be performed?

For simultaneous breast reconstruction on both sides (simultaneous bilateral breast reconstruction), all reconstruction techniques are possible, both with foreign tissue and with the patient’s own tissue. With certain techniques of reconstruction, both breasts must be reconstructed at the same time (for example, DIEP flap reconstruction from the abdomen); with other techniques (for example, infragluteal flap reconstruction from the bottom of the buttocks), both sides can be operated on at different times.

The great advantage of this procedure is that the operation is performed at a time when breast cancer has not yet occurred. Therefore, additional treatments such as radiation and chemotherapy are not necessary in this situation.

Treatment differences in mastectomy

How does Prophylactic Mastectomy differ from treatment for breast cancer?

If the breast is excised before breast cancer has occurred, all additional treatments such as chemotherapy, radiation of the breast, anti-hormone therapy and other drug therapies, which often account for a large part of the patient’s burden, are omitted.

The surgical treatment can also be much gentler. No lymph nodes have to be removed. This leads to less swelling, can lead to better breast reconstruction results and better preserves the defence and barrier function of the lymph nodes.

A more gentle procedure can already be used for the removal of the breast. In contrast to tumour surgery, the nerves to the breast skin can be partially preserved. This gives you the chance that the feeling on the breast skin remains better or can recover better.

When reconstructing the peeled breast, the stress of the operation can be spread over two operations, thereby also increasing safety. In this case, an implant is inserted first and the reconstruction with autologous tissue is only carried out in the second session.

We will be happy to advise you in detail on which options are best for you individually.