Risk Reducing Mastectomy and Reconstruction
Bilateral (left and right) risk-reducing mastectomy (BRRM) offers the greatest reduction in developing cancer in high risk individuals by removing in excess of 90% of the breast tissue. It reduces the risk of developing breast cancer by 85-100% in high-risk patients. It also showed that BRRM reduced the risk of dying from breast cancer by 81-100% in high-risk patients and 100% in the moderate risk group.
Uptake of BRRM varies amongst women in this high-risk group. Several studies have shown international variations in uptake of BRRM with the highest rates in the UK and the Netherlands (33-50%) and the US (36%) compared to Poland (3%) and Israel (4%). Differences in culture, healthcare systems and access to genetic testing are likely to contribute to these differences. However, wide variations are found within countries – for example in 3 different Canadian regions, the range of uptake was from 8-46%– suggesting that other factors are important.
Media coverage and public interest in BRRM has been heightened since 2013 when Angelina Jolie’s revealed her personal experience of bilateral mastectomies based on her inheriting a mutation in the BRCA1 gene from her late mother. The so-called “Angelina Jolie Effect” occurred with increased uptake of genetic testing and BRRM in the US and UK
Bilateral mastectomies and reconstruction with use of implants or own tissue (autologous) can be discussed. The protocol includes a discussion in a multi-disciplinary team and access to a psychologist to ensure that the individual is well prepared to undertake the surgery.
