Considering risk-reducing surgery


Risk-reducing mastectomy
Discovering you are at a higher risk of developing breast cancer can come with many challenging decisions and questions. There are several things which can help to reduce your risk of breast cancer (for more information see http://breastcancernow.org/information-support/have-i-got-breast-cancer/screening-risk-reducing-treatment-breast-cancer#risk-reducing-surgery). One major decision may be surrounding risk-reducing (prophylactic) mastectomy.

A risk-reducing mastectomy is typically offered to those at high risk of breast cancer and comprises of the removal of either one or both breasts to reduce the risk of breast cancer.  A person undergoing risk-reducing mastectomy may be offered a breast reconstruction at the time of the mastectomy (immediate reconstruction) or at a later date (delayed reconstruction).

How might a risk-reducing mastectomy affect me?
There may be clear medical reasons for having a risk-reducing mastectomy.  Every woman making this decision will have their own experience of living with cancer risk and have a unique response to surgery.  However, there are some common experiences which are important to consider:

  • Physical impact of the surgery: As with any other major surgery, risk-reducing mastectomy poses risks and potential complications. The surgery  may lead to short-term and longer-term changes in your physical functioning e.g. upper body strength, ongoing pain or discomfort. You can also access information regarding pain management here: Sherwood Forest Hospitals (sfh-tr.nhs.uk).  A risk-reducing mastectomy removes all tissue from the breast, meaning that you will not be able to breastfeed from one or both breasts (depending on the type of mastectomy) in the future.
  • Body image and self-esteem: A risk-reducing mastectomy may affect your body image.  It may lead you to feel more self-conscious or experience difficulties with feelings of femininity.  Sometimes the results of surgery are not as anticipated, and this can lead to disappointment, distress or frustration.  Alternatively, you may feel happier with your body than you did before. (You can access information regarding support with body image issues here: Sherwood Forest Hospitals (sfh-tr.nhs.uk))
  • Sexual functioning: Concerns about body image may negatively affect your sex life, as may reduced breast and nipple sensation and sensitivity, which may hinder sexual arousal. (You can access information regarding sex and intimacy here: Sherwood Forest Hospitals (sfh-tr.nhs.uk))
  • Anxiety: A risk-reducing mastectomy may be considered by women wishing to reduce their anxiety about developing breast cancer.  It is important to understand that whether or not you have had breast cancer, the risk of cancer can never be entirely removed.  As such, it is not possible to guarantee that the surgery will remove all anxiety about cancer.

Given the above considerations, some women decide to go ahead with a risk-reducing mastectomy with or without reconstruction, whereas others decide that it is not the right thing for them, or that they do not wish to go ahead with it at this time.

What is the role of clinical psychologists in risk-reducing mastectomy?
Here at Sherwood Forest Hospitals Trust, anyone considering a risk-reducing mastectomy will meet with a clinical psychologist before going through surgery. The clinical psychologists are here to support you in thinking through your decision with someone independent.  As psychologists working in cancer services, we are very familiar with the impact that living with an increased risk of cancer can have on psychological and emotional wellbeing.  Psychologists are trained to understand how people think, feel and behave, and we have experience in understanding the psychological impact of risk-reducing mastectomy.  We can also advise you about any psychological considerations which may be relevant to your circumstances.

Seeing a clinical psychologist may highlight that while a risk-reducing mastectomy is the right decision, you may require additional psychological support whilst undergoing this procedure.  In this case, seeing a clinical psychologist can allow this support to be put in place from an early stage. This might include one-on-one talk therapy, group therapy, or access to support groups.

Specific supports that clinical psychologists can offer:

  • Pre-operative counselling for anxiety surrounding the surgery 
  • Exploring expectations about changes to your body (e.g. changes to your appearance or sensations) and the impact this may have on you and your relationships.
  • Psychological support post-operatively and after discharge.

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