Bilateral Mastectomy: Your Choice. One Side or Both?

We teach you about bilateral or “double mastectomies.” You will learn about the advantages, disadvantages, and controversy of this approach to reducing your future risk for a new breast cancer.
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Questions for your Breast Surgeon:
1. Will I improve my chances of survival with a “Bilateral Mastectomy?”
2. What are the disadvantages of a “Bilateral Mastectomy?”
3. What are the advantages of a “Bilateral Mastectomy?”
Isn’t it my choice to decide?
4. If I’m unsure, can I talk to a plastic surgeon?
5. What is a “Bilateral Mastectomy”?
Also called a “double mastectomy,” this is when both breasts are surgically removed. The term “Contralateral Prophylactic Mastectomy” is also used by the medical community for removal of the opposite, non-cancerous breast. Most of the time the decision to have a bilateral mastectomy is a personal one and is not required to treat a breast cancer that is on one side.
There are situations where a “bilateral mastectomy” may be offered for consideration by your breast surgeon. The medical aspects are more complicated than listed below, but we include some common scenarios.
Cancer in both breasts
BRCA (“breast cancer gene”) mutation or other high-risk genetic mutation
Strong family history of breast cancer
Younger than 35 with breast cancer
High risk for developing a new cancer
Radiation to your chest at a young age
Am I at risk of developing a “New Breast Cancer” in my other breast?
Simple statistics are important to understand this concept. Below is a common scenario where women consider undergoing bilateral mastectomies to treat their existing cancer and reduce the risk of developing a new cancer in the other breast.
Let’s say you are 45 years old, have an early, Stage I or II breast cancer and either need or have chosen to have a mastectomy to treat your cancer effectively. What is your risk of developing a new breast cancer in the other breast in the future?
If you were just diagnosed with breast cancer and have no other risk factors, you will have a slightly higher overall risk of developing a totally new breast cancer in your lifetime. This risk rises from the normal lifetime risk of 8% for both breasts to approximately 12%, assuming a lumpectomy is performed and you keep both breasts.
If you are in this situation and are trying to decide if you want a bilateral rather than a mastectomy on one side, your risk of developing a new cancer in your lifetime in the other breast if you choose to keep it is about 6% (half of the 12% above). We cure about 90% of all breast cancers with current treatments. Therefore, your lifetime chance of dying from a new cancer in that other breast will be about 0.6%.
“Bilateral Mastectomy” for cancer on one side?
Most of the time the choice to have a bilateral mastectomy is a personal one for a variety of reasons. Even when well informed, many women decide to proceed with removing both breasts for “peace of mind” and the desire to “never go through this again.” It is important to realize that everyone has different goals, unique personal situations, and their own reasons as to how they manage their own breast cancer. “Patient autonomy” is essential to a great “doctor-patient” relationship.
Controversy about “Contralateral Prophylactic Mastectomy”
There has been a trend over the last decade of more women choosing a “double mastectomy” when they have cancer in one breast. About 25 to 50% of all mastectomy surgeries done today are “bilateral” procedures. The more informed you become, the better decision you will make for your own situation.
There is an intense debate by breast specialists as to whether too many bilateral mastectomies are being performed.
What are the “disadvantages” of a bilateral mastectomy?
Surgical complication risks are slightly increased
Loss of sensation in the skin of both breasts
Increased need for revision surgeries in the future
Does not improve your “overall survival” from breast cancer
Does not lessen the chance you will need chemotherapy
A chance you might regret the decision in the future
What are the “advantages” of a bilateral mastectomy?
Lessens the chance of a new cancer in the breast
Screening mammograms are no longer needed
Cosmetic outcomes have improved over the last decade
Reconstructing both sides gives matching cosmetic outcomes
Discuss with your Breast Surgeon
Work to develop a close relationship with your breast surgeon. Print out and take these course notes with you when covering this topic. Ask to see a plastic surgeon about reconstruction options if you are unsure. Ultimately, your breast cancer treatment decisions are yours to make.

[@patriciaschuster1371]

I had breast cancer 10 years ago, losing my left breast. I contemplated a double, but I was frightened enough with the one. Many lymph nodes were tested first. So many were active so I had a modified radical mastectomy. Hate that it was an outpatient surgery for most, but my doctor gave me 3 days and two nights in hospital. Chose not to have reconstructive surgery. I am cancer free now. Had chemo and radiation. My hair never came back totally, thanks to the known among the drug company fact, not discosed to patients. But I am alive, with an extra ten years of living. Worth it, despite lies from manufacturer. Now there are cold caps used during chemo, which make a difference. Peace and health to all the other women in our place.

[@stephancroels902]

I am so happy to hear you are doing okay. I am sorry that you had to lose your hair permanently. That would really be a terrible thing to go through. Despite that, it seems as if that chemo worked for you.. maybe a silver lining? Thanks for sharing. I really wish you all the best :) xx

[@LawkittyTiffany]

Ty 4 this

[@SofiaAhmad-rp8sm]

That great to hear that,which stage was your breast cancer

[@janealcoseba1453]

Mastectomy axillary i lift my 1 breast right last January 22 2024 now im suffering swelling my armpit area🙏🏻🙏🏻🙏🏻

[@Vickygarcia73]

Thank you , I having a mastectomy on the 25 . Your information has reassured me , I had made the right decision. I want to let you know I do appreciate the kindness of your voice , and how you make this so simplified to help us to understand.

[@motherof1132]

I had a lumpectomy and it had spread. At the end, I had a double bilateral Mastectomy. I decided to have flat closure. I had chemo and radiation. I didn’t want to do reconstruction with the many surgeries and issues. My chest is a bit numb. My libido went down due to having no breasts. I’m 50. I look like a girl so I don’t need reconstruction. No one really wants to wear a bra. 😊

[@stephancroels902]

Hi, thanks for sharing your story. What stage was the cancer when you had a lumpectomy? Did you have radiation as well? I have extensive DCIS in one breast and very strong family history of breast cancer. I am struggling to decide what to do. Thanks again for sharing :) xx

[@sopranozinger]

Thank you. This reinforced what my surgeon and oncologist recommended. Just 2 weeks post bilateral. Recovering.

[@Whoknows5464]

I am just starting the research an you’re video’s are very informative.. I have my biopsy for right breast and lymph nodes this Tuesday.. My doctor has done all the imaging this week an we will be starting chemo as soon as she gets it lined up.. I’m learning bc I’ve never had anyone close to me have breast cancer and it’s all new to me.. Thank you for your time in making these videos it’s really helpful

[@nonyabiness4023]

I had bc in the right side 12 years ago. Lumpectomy and radiation. I was diagnosed again in early September. Same side. I already knew radiation was not an option. I got a firm bilateral mastectomy! Trying to match a prosthetic breast or surgery to match. I’ll pass. I’m 51. At this point I’m over it! I don’t want it back on the other side. Bye Thelma and Louise! Hello Mary Kate and Ashley Olsen!

[@nilriaoliveira3720]

How are you doing?

[@nonyabiness4023]

@@nilriaoliveira3720 I’m cancer free thank God. A lot of complications last year but I made it through! Healing more every day. Most side effects are gone. Still mild fatigue and still getting muscle strength back, I’m well! Thank you 🫶🏽🌷

[@sdypg]

I wish I had found these videos before breast cancer in July this year. I was so unhappy & overwhelmed. Had a double mastectomy although only 1 breast had a lump. For symmetry & not having to go thru another mastectomy again. I can say, I feel free & my surgeon was very good to me. Why do we have coils upon coils of drainage. So discomforting.

[@cindytracy4908]

Thank you for this informative video. Helped me tremendously.

[@jhulialandown8516]

Thank you Dr. Williams 🙏🙏🙏

[@dubie-day-shay7937]

Thanks 4 this information! Great job!

[@BreastCancerSchoolforPatients]

You are too kind. Make sure to visit the Breast Cancer School for Patients for more information. www.breastcancercourse.org. Good luck.

[@miniteelucksingh4464]

Great information. Thank you.

[@BreastCancerSchoolforPatients]

Make sure to visit our entire video based Breast Cancer School for Patients to learn more about your unique situation. www.breastcancercourse.org

[@amazingbirminghamhomeswith3677]

Thank you

[@carolallnutt8036]

Thank you this has been very helpful

[@BreastCancerSchoolforPatients]

You are too kind. Make sure to visit the Breast Cancer School for Patients for more information. www.breastcancercourse.org. Good luck.

[@paulinhapintobastos2238]

It' s importante to put flat closure as an option to be considered too. That was my choice. TKS.

[@mssoulsister2186]

Please talk about TRIPLE NEGATIVE BREAST CANCER!

[@BreastCancerSchoolforPatients]

Go to the Breast Cancer School for Patients and take our specific lesson on it. www.breastcancercourse.org/triple-negative-cancer-2/ I hope it helps.

[@addisalemmekonnen2160]

@@BreastCancerSchoolforPatients

[@rainy.d7404]

Surgeons need to help their patients to make better informed decisions. Having one breast removed withought reconstruction and having large breasts is not ideal. Upper back muscle and nerve pain is very challenging and can stop a woman from being able to workout due to the fear if severe pain. I suggest getting either both breasts removed at once or getting the other breast reconstruction asap. Having to rely on breast prosthetics is not fun. It's very uncomfortable sleeping too when you only have one large breast. The trauma is real.

[@redstarseed514]

Wow thanks so much for that info. Yes these kind of information, they don’t even think it’s important to tell us.

[@user-nx3yu9iu1p]

Going through this now. That's what I'm saying. .... Been having breast all my life and you only once to remove one! That's dumb! Take them both and I really don't care about reconstructive surgery.

[@LostinTranslationss]

After 15 years of follow up the lumps, I just diagnosed cancer on my right breast. Lumpectomy with RT. If I have cancer again either left or right. I will do bi-mastectomy without reconstruction. I’m really done with anxiety and stress.

[@nflower7337]

IHOPe all doctors like you 🙏🌹🌹

[@BreastCancerSchoolforPatients]

Thank you for the feedback. Make sure you visit the complete Breast Cancer School for Patients. Same video lessons, but organized in the order of topics you will experience them. www.breastcancercourse.org/

[@lailanielubi335]

Can you please educate us regarding TNBC or Triple Negative Breast Cancer like my case on my Er Pr Her2nue all are negative. Is there any medication on this? Like the other Er Pr Her2nue.

[@roselucht4583]

It completely depends on the type of cancer

[@yvonnequinones3972]

My surgeon Dr. Kamali said I could choose a bilateral or unilateral mastectomy . I had a unilateral mastectomy and was able to skip chemo and radiation and meds. My OncotypeDX number was a 9.

[@jyienger]

How are you doing today?

[@Chericherry4]

I will start chemo soon and then will have surgery. I’m thinking bi-lateral for a more balanced look with pads or prosthetics, later. I don’t want to go through reconstruction but I still have time to reconsider.

[@margodilbeck5378]

Awesome doctor😕👍

[@mistyliffey.ie-abe7]

I have been told my best option is a mastectomy I'm not sure if I can request bilateral surgery I feel that it would relieve the stress of breast cancer returning and not having to wear a bra or having mammograms would help aid recovery and help relax my mind to enjoy life more

[@raqueldelao7840]

I wish you were my doctor

[@virginiasnowden5416]

Thank you so much. This is so helpful to me. I am trying to decide what is right for me. Just cancer in one breast.

[@jeanelleallen4802]

Getting a bilateral mastectomy Thursday going through a lot, trying to understand what's about to happen 🥺🤯😳

[@BreastCancerSchoolforPatients]

Good luck on all of this. Make sure to visit the formal Breast Cancer School for Patients at www.breastcancercourse.org to learn more.

[@Ajm19857]

I had a bilateral mastectomy may18th and i could never prepare for the emotions i experienced before and after my surgery. I just take it one day at a time. having support is important.

[@ItalianainDC]

@@Ajm19857 how are you doing now? I have to decide what to do, I do not want radiation and 10 years hormonal therapy that I would have to have with a lumpectomy , but a bilateral mastectomy is really scary to me….

[@Ajm19857]

@Anna Maglione I am done with chemo and surgeries for now. I had and still have side effects from chemo and current medication I am on. I am taking it one day at a time. That is all I can do at this point. As for making Decisions I have a support system. Two specific people who have been there through everything. My husband and sister in law. I talked about the Decisions I would have to make with them because I was really overwhelmed. Ultimately everything is my decision but they have helped me throughout the process.

[@marcysikes]

My hospital has Nurse Oncologists who are called nurse navigators. They are wonderful! They help me understand my options and are super supportive of whatever I decide. They follow my progress and are available to me when I need them.

[@cigarosports9910]

Do we still need chemotherapy and hormonal therapy after we had surgically removed 1 breast with the lump? Please lemme know.

[@laurelbrennan6295]

In 2004 I was diagnosed Stage II right breast, had lumpectomy, chemo and radiation. 2017 I was diagnosed Stage I left breast, after finding 2 cm lump via MRI, I had lumpectomy and radiation (no lymph nodes involved). I had genetic testing which showed no BRCA genes. Since my grandmother died of ovarian cancer, there are greater risks for developing again. Well, in the past few weeks I've had annual mammogram, ultrasound and MRI and found a 1.2 cm area back in my right breast with calcifications; and will have a ultrasound//biopsy Wednesday. Based on this recurrence, is it recommended that a mastectomy be done on the right, or, since both breasts have had cancer...that a bilateral mastectomy is needed. In 2017, the MRI did not show anything going on in the right breast. So this growth occurred within 2 years. Appreciate any info you have.

[@BreastCancerSchoolforPatients]

Make sure to visit our entire video based Breast Cancer School for Patients to learn more about your unique situation. www.breastcancercourse.org

[@mikimiki6202]

Did you get any medication to block estrogen?

[@marcodeluca4068]

How can we be sure that it’s cancer when so many can false cancer reading isn’t there a chemical or biological or is it based on visual determination???

[@maryjostarks8351]

I'm wondering how insurance companies feel about double bilateral mastectomy if cancer is only in one breast?

[@rebornefit]

It’s the law that they cover it.

[@KimberlyGingrich]

What is a good option for a person with Stage 4 breast cancer, with only one side affected? a single or double Mastectomy?

[@AU-vl1vi]

My doctor said , your prognosis will be the same rather you touch or not the unaffected breast. It’s just for looks but my outcome is the same.

[@tdotgh3791]

Can I refuse a mastectomy for IBC

[@mkliyan]

Can you have skin/nipple sparing masectomy without reconstruction?

[@aishaibrahimusman3928]

Yeah

[@kdgenereau9743]

I had to have a biladderal mastectomy with 14 surgeries & 3 implants. My Dr said my exrays showed that my breasts were filled with tumors. Ever since I had the surgery, my health has dramatically fallen. I developed an infection with a hugh pus pocket on the outside. They removed it & there's an indent next to my nipple. I can hardly feel my right breast.