Prophlactic Mastectomy

I had a prophylactic mastectomy 6 months after my involved breast was removed.  I did not have any lymph nodes removed from the prophylactic side and have no restrictions regarding blood draws, etc.

I had a prophylactic at the same time as my other breast was removed. My BS normally does a Sentinel Node Biopsy on the prophylactic side as well, but I had the same concerns as you about lymphedema etc -- so I told her that I did not want the SNB done on that side. She did say that doing a SNB on the prophy side is not standard practice but she prefers to err on the side of caution. But of course the decision was up to me, and because there was no indication on the mammo or ultrasound of any problem in the other breast, we reached a compromise: I would get a contrast MRI done of the breasts before surgery, and if the other breast was "clean" then she would not do the SNB on the prophy side. That's exactly what happened, and so the SNB was not done; the pathology of the prophy side showed no evidence whatsoever of cancer, by the way.



You might want to propose this same compromise to your BS if he or she normally does do an SNB on the prophy side. As my BS explained, most surgeons do not do this but the more cautious or thorough ones do.

Barbara, that's a very good point about the SNB! One I didn't think to ask because the moment my BS brought up the subject, I immediately knew that I didn't want to have to deal with two risk-prone arms instead of just one, especially since the prophy was on the right and I am right-handed. And there was no indication on either the mammo or the ultrasounds that were done before surgery that any abnormal cells existed in that breast.



I poked around online and found some info on the subject; they inject the dye into the periaureolar region (fancy name for "around the nipple"). http://www.ncbi.nlm.nih.gov/pubmed/16955504 The title of the paper is "Selective Use of Sentinel Lymph Node Surgery During Prophylactic Mastectomy."



But how exactly they trace where the dye goes from the points of injection is something I don't know. I don't subscribe to PubMed and so can't read the entire study (which I'm sure describes it all in detail), only the abstract.

gosh, if your doc thinks you are brca positive, maybe you should go ahead and have the testing done.  I figure your insurance company would pay for that and surely if you are postive they will pay for the prophy mx.

I have a bilateral MX and went to the point of insanity figuring out whether to do sentinel bx or not.  Like you, I was really concerned about the long term implications since we were talking about both my arms, etc.

I agree with others who posted that you can have an MRI and if they find nothing then skip the sentinel.  I did this.  We had some areas of enhancement and biopsied them prior to the mx.  All b9, so we went ahead with the surgery, no sentinel and happily there was no cancer.  I have no signs of LE and have had blood draws from my non dominate arm.  There is always some chance of LE, even with no nodes out, but extensive (I mean really extensive) research showed me this is very, very rare.  

Good luck to you in your decision!!!  

Hi starzhere,  I had a bilat mx, right side was prophylactic, they did not do sentinel node biopsy on the right side, found benign hyperplasia in right breast during surgery, that did not show up in MRI I had prior to surgery.  I am about 9 months out from my surgery and I still get scared just thinking about having cancer. I was lucky though because they caught mine so early, I didn't have to have rads or chemo, no Tamoxifen either.  It still is tough because it changes your life so much.  I really don't miss my breast, I just miss my normal, so now I am trying to make a new normal.  I am so grateful for kind people, this website and all the support I have had from my family,freinds and co-workers.  I would definitely discuss your options with your surgeon, if there isn't any reason to do the SNB then don't do it. I have several friends with only one breast and they are thinking about having the other one removed as well or wish they would have done it to begin with, that is one reason why I had the BMX because of talking to all of them.  I felt it was the best decision for me.  I know you will get the answers you need and  I will keep you in my prayers.

Re the SNB for my prophylactic mastectomy: Barbara made a good point about how do you know where the sentinel node is if you don't have the tumor as a starting point to inject the dye. But I checked my pathology report, and it says that two sentinel nodes were removed from level 1 on the prophylactic side. I'll have to ask my surgeon when I see her for my next checkup how she chose those two.