Description of Treatment/Procedure

Bilateral prophylactic mastectomy is defined in this report as the surgical removal of the breasts (at a time when no breast cancer is present) for the purpose of reducing the risk of developing breast cancer. The procedure currently used is a simple or total mastectomy which allows removal of 95% or more of the breast tissue. Much of the existing data is from patients in whom subcutaneous mastectomy was performed (removing 75% to 95% of the breast tissue) for indications such as mastodynia, multinodular breasts, and multiple breast biopsies which by current standards would not be considered of sufficient risk to warrant the procedure.

Committee Summary

With regard to bilateral prophylactic mastectomy to reduce the risk of breast cancer, the ICSI Technology Assessment Committee finds the following:

1. On the basis of retrospective data, there is evidence that prophylactic mastectomy reduces the risk of breast cancer in women at moderate to high risk of disease as defined in this report (Conclusion Grade I).
   
2. On the important question of the psychological well-being of patients undergoing the procedure, there are no data yet available.
   
3. Prophylactic mastectomy is an option for patients at high risk for breast cancer (and select moderate risk patients) only after extensive education and counseling about the procedure and the potential outcomes.
   
4. Prophylactic mastectomy is a technically safe procedure. However, since the majority of women choose reconstruction, the complications pursuant to reconstruction (which are more frequent and potentially more serious) must also be considered. Patients need to be aware of the expected complications and cosmetic results.