SUB Q MASTECTOMY @ 21

[SUB Q]

I HAVE A VERY STRONG FAMILY HX OF BREAST CANCER ON MY MOTHERS SIDE OF THE FAMILY, MY MOTHER AND MYSELF BEING THE ONLY ONES NOT DX W/ EITHER BREAST CANCER OF PRE CANCEROUS ACTIVITY(MY MOM HAS FIBERCYSTIC TISSUE SHOWN IN HER LAST 3 MAMMO'S SHE IS 41). I WENT TO SEE PLASTIC SURGEON TO CHECK ON BREAST AUGMENTATION SX DUE TO A 3 CUP SIZE DIFFERENCE IN MY BREAST AND WHEN WE GOT INTO MY FAMILY HX PART OF THE REVIEW OF SYSTEMS HE SUGGESTED THAT WE CHECK W/ MY INS TO SEE IF AND WHAT THEY WOULD COVER MASTECTOMY WISE DUE TO STRONG FAMILY HX. SUB Q MASTECTOMY IS THE ONE THAT MY DOC HAS SUGGESTED AND I AM NERVOUS(MY DOC IS AWARE OF MY ANXIETY ON THE ISSUE). IS THIS PLAN OF ACTION SOMETHING THAT IS NORMAL?

[osgrl]

hi, i am 24 years old and had bilat. sub q mastectomies 2 months ago for adh (atypical ductal hyperplasia) and severe fibrocystitic breasts. i have no family history of breast cancer. was also interested in augmentation. my insurance paid. i am very happy with my choice. now, its not the easiest thing to go through. lots of pain. i currently have expanders and will eventually have them replaced with silicon implants. do your research before you make a decision and good luck!

[surgeon]

A few points to clarify: fibrocystic "disease" is not a cancer risk factor. Family risk factor derives mainly if you have a mother or sister with breast cancer. Under the circumstances, I doubt any insurance would pay for prophylactic mastectomy. If you were shown to have the gene, which seems not very likely, that would make a difference. Finally, subcutaneous mastectomy is not a good cancer prevention operation because it will leave some breast tissue in place. For women who have the gene, cancer prevention surgery means the complete removal of both breasts.

[CCF-RN,MSN-rf]

Dear Sub Q:  It seems you are talking about two different issues.  Mastectomy is not used for cosmetic reasons.  Mastectomy can be done for prevention when it is clear that the risk is high (as outlined by a genetic counselor).  If it is determined that your personal risk is, in fact, high (you have no first degree relative with breast cancer), then you could entertain a mastectomy with reconstruction.  Realize, though that if you are doing mastectomy for prevention, then it should be bilateral.  Your insurance may or may not cover this, regardless of risk.  On the other hand, if your concern is regarding a 3 cup size difference, you can consider saline implant in the smaller breast or reduction in the larger.  You need to separate the issues of risk and cosmetic.  If risk is your concern, address this first and then determine a cosmetically acceptable solution.  First, see a genetic counselor and determine your risk.