Reducing Inherited Risk

Learning you have increased hereditary risk for breast cancer can be frightening and overwhelming. The knowledge can also be empowering, providing an opportunity to proactively manage and reduce your risk. Each of the following risk-reducing actions has benefits and limitations. Each should be carefully considered before choosing the path that is best for you:

• Reduce lifestyle factors. Observe lifestyle factors known to decrease breast cancer risk: maintain a healthy weight, eat a balanced diet, exercise consistently, avoid alcohol and smoking, etc.
• Increase surveillance. This includes annual mammograms starting at age 40, annual MRI, ultrasound and clinical breast exams to help identify early-stage breast cancer.
• Take risk-reducing medication. When taken for at least five years, Tamoxifen reduces the risk of developing breast cancer by almost 50% in high-risk women. Researchers are studying the risk-reducing effectiveness of other drugs, too. Ask your oncologist about Tamoxifen and other preventative medications that may help reduce your breast cancer risk.
• Undergo prophylactic mastectomy (with or without reconstruction). Removing breast tissue is the most drastic course of action, but it is the most effective, reducing breast cancer risk in high-risk women by 95%.

Prophylactic mastectomy with immediate breast reconstruction

Compared to mastectomy to treat cancer, a prophylactic mastectomy and reconstruction has distinct advantages over traditional mastectomy and reconstruction. Surgical incisions can be less invasive, leaving little or no visible scars on the new breast. In many cases, women can retain their own nipples and keep much of their post-mastectomy sensation. Their reconstructed breasts can look as good or better after mastectomy as they did before.

Prophylactic mastectomy is a tough choice. If you decide it is the best way to reduce your hereditary risk of developing breast cancer, your mastectomy can be performed in a less invasive, more aesthetic procedure than if you were having a mastectomy to treat cancer.

You may be eligible for a subcutaneous procedure (the breast tissue is removed through an incision hidden underneath the breast) that allows you to retain your own nipples, areolas and much of your current breast sensation.
Dr. Salzberg has many patients-including women in their 20s and 30s-who choose prophylactic mastectomy. He frequently performs immediate One-Stage Breast Reconstruction with Implant and AlloDerm® following subcutaneous, nipple-sparing mastectomies