Immediate reconstruction can be done by placement of implants under the chest wall muscle or by rotating muscle and skin from another area of the body. When immediate reconstruction is performed, studies have shown that it is psychologically a benefit to the woman. Of course, reconstruction is a personal choice, and every woman makes a choice based on her own personal feelings.
One of the most common reasons that a woman has a double mastectomy is when she is found to be carrying a gene mutation that gives a very high lifetime risk of breast cancer. For example, the BRCA 1 and 2 gene mutation (like the mutation Angelina Jolie carries) gives a high risk of breast cancer by age 70 (from 50-80% risk). We know that by removing the breast tissue it decreases this risk by 98%.
In other cases, a woman with breast cancer or “pre-cancer” changes in one breast may choose to have a double mastectomy. They may make this decision so both breasts look the same.
In America, unlike Europe or other parts of the world, more women are choosing to remove both breasts, when they have cancer in only one breast. There are several thoughts as to why women are making this choice, but these are only speculative, as the exact reasons for increased double mastectomy in the United States are unknown.
- Increased awareness of genetic mutations for breast cancer that gives a woman a very high risk of breast cancer in either breast over her lifetime. Double mastectomy in women with a genetic mutation decreases her risk of breast cancer in either breast.
- Symmetry: Women who are having a mastectomy on one side may choose to have the same operation on the other breast so the breasts look the same.
- Improvement in techniques for double mastectomy: It is now common to leave the nipple and areola, and the skin envelope of the breast, so that the breast retains a more natural appearance after mastectomy.
- Improvement in techniques for immediate reconstruction, including implants and skin and muscle rotation into the area to recreate a breast.
- Overestimation of risk of breast cancer coming back in the opposite breast. With the advances in treatment of breast cancer over the past 20 years, this risk is actually much lower than many people may think (5% after 10 years of treatment).