An expert explains: Risk reducing surgery for breast cancer

Risk reducing surgery can dramatically lower a person’s likelihood of developing breast cancer should they carry an abnormal gene which makes them more prone to the disease. In this informative guide, renowned consultant oncoplastic breast and general surgeon Miss Jasdeep Gahir provides expert insight on who may benefit from risk reducing surgery and its advantages as well as explaining what patients should consider before undergoing this preventative procedure.

What is risk reducing surgery?

Risk reducing surgery for breast patients applies when a person has a family history of breast cancer or it has been detected that they carry a gene that increases their risk of developing breast cancer.

Abnormal genes such as BRCA1 and 2, TP53 or PALB2 can significantly elevate a person’s breast cancer risk and so patients who are known to have carry them are candidates for surgery to reduce the likelihood of them developing the disease. Normally, their individual case would be discussed at a multi-disciplinary meeting of various specialists to establish their lifetime risk of developing breast cancer. Once this has been explained to patients, some may prefer close monitoring whilst other opt for risk reducing surgery.

At this stage, the patient might not have breast cancer but chooses to take the breast tissue away to lower their risk. They may also possibly opt for a reconstruction of the breast. In some cases, patients may originally present with a breast cancer tumour and following genetic testing, are also identified as carrying an abnormal gene. Considering this, these patients may choose to undergo therapeutic surgery on the side where cancer is present as well as risk reducing surgery on the other breast to prevent further problems.

Which genetic mutations increase the risk of breast cancer?

Abnormal genes which can increase a person’s risk of breast cancer include:

• BRCA1
• BRCA2
• TP53
• PALB2

Advances in the field of genetic testing mean that we are continually expanding our knowledge and discovering more genes and as such, the pool of genes linked to breast cancer will inevitably increase.

Who is a suitable candidate for this surgery?

The cohort of patients with these genetic abnormalities is actually very small. For me, any patient can be considered suitable for risk reducing surgery if they carry one of the abnormal genes and they are at increased risk of developing breast cancer. In this case, we also have to consider if the patient is fit enough to undergo an operation and establish what is most appropriate for their individual circumstances.

When offering risk reducing surgery to patients suffering from other conditions such as diabetes or who take medications such as steroids or are smokers, immediate reconstruction is often advised. Importantly, these patients are at increased risk of complications and so it is vital they appreciate the complexity of reconstruction.

Is risk reducing surgery painful?

In most patients, risk reducing surgery involves a bilateral (double) mastectomy, which is a painful procedure. Additional to this, there are different forms of reconstruction. This may be merely implant-based, meaning a shorter operation but can be more complex if it involves using some of the patient’s own tissue from elsewhere in the body, such as from the tummy. Longer and more complex procedures usually mean the patient requires more pain relief following surgery.

What are the pros and cons of risk reducing surgery?

If you are an abnormal gene carrier and you don’t wish to undergo risk reducing surgery, you can be closely monitored to see if the cancer develops. However, by having risk reducing surgery, you decrease your lifetime risk of developing a breast cancer tumour by about ninety-five per cent.

Depending on the type of abnormal gene you carry, your lifetime risk of developing breast cancer can be between fifty and eighty-five per cent. Therefore, undergoing risk reducing surgery decreases your risk dramatically which is obviously advantageous but it is a personal decision and not every patient chooses to have it done.

If you have a family history of breast cancer or are an abnormal gene carrier and wish to further discuss if risk reducing surgery may be right for you, don’t hesitate to schedule a consultation with Miss Gahir by visiting her Top Doctors profile.