Prophylactic mastectomy is discouraged unless there is a clear indication for its performance.
Patients making the request include:
(1) a patient without breast cancer who is at high risk for breast cancer
(2) a patient with breast cancer who wants to have the contralateral breast removed
Indications:
(1) a high-risk genetic mutation (BRCA, other)
(2) a strong family history AND a personal diagnosis of breast cancer at an early age
The presence of bilateral breast cancers would make a mastectomy not truly prophylactic.
Other factors that may influence the decision:
(1) recurrent breast cancer after appropriate breast conserving management
(2) extreme psychological distress when denied surgery
(3) triple-negative breast cancer
(4) unable to have adequate clinical follow-up for a prolonged period
(5) strong family history without an early diagnosis of breast cancer
