What is a double mastectomy?

When cancer is found in both breasts or there’s a high risk of developing breast cancer, a double mastectomy may be an option to treat or prevent breast cancer. 

This surgery removes all breast tissue. It can be performed with or without breast reconstruction surgery, either at the same time or as a separate procedure.  

We spoke to surgical oncologist Rosa Hwang, M.D., to learn more about this procedure and what patients can expect before, during and after a double mastectomy. 

Who needs a double mastectomy? 

Very few patients need a double mastectomy, but there are some cases where patients and their care teams may decide to seek this treatment option, if they meet certain requirements.

The National Comprehensive Cancer Network’s guidelines outline which patients may benefit from double mastectomy. These include patients who have:

• certain genetic mutations, like BRCA1 and BRCA2, that put them at increased risk for developing breast cancer, 

• cancer in both breasts,  

• several close family members who’ve been diagnosed with breast cancer at a young age, and/or

• a history of radiation therapy to the chest.  

Patients with a tumor in one breast may consider a double mastectomy, also called a bilateral mastectomy, for cosmetic reasons to achieve symmetry in the other breast.  

What are the alternatives to double mastectomy? 

When you have breast cancer, your first instinct may be to remove all potential for it to grow or spread. But surgery isn’t the only option for many patients. Even if you’re at high risk for developing breast cancer, there are non-surgical treatment options that don’t require a double mastectomy. These include more frequent screenings and surveillance. 

MD Anderson patients can seek care from our High-Risk Screening and Genetics Clinic, where they’ll receive frequent mammograms and/or breast MRIs to detect cancer early, when it’s easiest to treat. 

Talk to your care team to see if you’re eligible for more frequent screenings instead of surgery.

What are the different types of double mastectomy? 

There are several different surgical techniques that can be used during a double mastectomy. These include: 

• Total mastectomy: This surgery removes all the breast tissue, including the skin and nipple. 

• Skin-sparing mastectomy: Breast tissue is removed along with the nipple and areola, but the skin around the breast is saved. This leaves a “skin envelope,” which allows for breast reconstruction surgery at the same time, either with implants or your own tissue. This approach offers a more natural appearance after patients recover. 

• Nipple-sparing mastectomy: This technique is the most complex option for mastectomy; it saves the skin as well as the nipple-areolar complex. Nipple-sparing mastectomy is performed with reconstruction at the same time, similar to a skin-sparing mastectomy. Surgeons remove tissue inside the breast but save the skin, nipple and areola.  

Your recovery time will depend on which surgical approach you receive and whether you undergo breast reconstruction. This can range from two weeks for total mastectomy with no reconstruction to 4 to 8 weeks after mastectomy with reconstruction using your own tissue.

What are the risks associated with double mastectomy?

As with any surgery, there are risks associated with double mastectomy. And, because the treatment involves two different spots on the body, that risk is doubled. 

With skin-sparing and nipple-sparing mastectomy, there’s risk that the skin and nipple will lose blood supply and die or lose sensation. Bleeding and infection are also possible side effects of surgery. That’s why it’s so important to seek care from a surgeon with experience performing this specialized surgery to get the best result and minimize risks.

Anything else patients should know about double mastectomy? 

A double mastectomy can be beneficial for some patients, but it’s not right for everyone. Having both breasts removed is a big decision, and you want to make sure that it’s the right one for you based on your quality of life and personal treatment goals. 

Talk to your care team to see if a double mastectomy makes sense for you and your breast cancer treatment goals. 

Request an appointment at MD Anderson online or by calling 1-877-632-6789.