Why, and advised by whom?

I would get a second opinion by a breast surgeon or two, first, if you haven’t already.

"By my physician because too many cysts, and cell changing which they dont know if this could lead to cancer"

"yep, no diagnoses really. my mom did early becasue of cancer (kidney) a cousin breastcancer but haven"t done any testing"

Prophylactic mastectomies is a HUGE step to take for anyone who is high risk, and most people take a long time - years even - to decide if it's what they want to do. This is major surgery that will change and affect your body for the rest of your life. Reconstructed breasts, no matter how good the reconstruction is, are not real breasts. This is particularly true of implant reconstruction - it's not the same as having implants for cosmetic purposes, when the implant is placed below the soft, warm, natural breast tissue. When it's just the implant that makes up the breast and nothing else, it's a replacement for a breast but it's not a breast.

Some questions for you:

• How old are you?
• What screening have you had done? Mammogram? Ultrasound? MRI?
• Have you had a biopsy? I'm assuming yes, since you mention "cell changing".
• How long have you been having issues?
• Who is this physician who has recommended this to you? Your family doctor, your OBGYN, or some other doctor?
• Have you seen a breast specialist?
• Have you had your risk level assessed by a genetic counselor and/or a Medical Oncologist?

.

Now, to the reasoning for having a prophylactic mastectomy.

First off, breast cysts are extremely common. About 60% of women have fibrocystic breasts, and with fibrocystic breasts comes a high likelihood of developing cysts. It can happen at any age, but the most likely years to develop cysts are between the ages of 35 and 50, the peri-menopause years, when our estrogen levels are fluctuating and doing weird things. Some women develop just one or a couple of cysts, and other women develop lots of them. I had quite a few. Cysts are almost always harmless, and often will eventually drain and disappear on their own. Large cysts can be aspirated. That's a 2 minute procedure where there doctor inserts a needle and syringe and pulls the fluid out of the cyst. I've had that done lots of time. Generally the development of cysts slows down or stops once a woman is into menopause. I still got cysts after menopause, but instead of a large number of large cysts, I'd just get the occasional small one. A recommendation to have prophylactic mastectomies because of breast cysts? That's practically unheard of.

"Cell changing" I assume to mean that you have had a biopsy and have some type of atypia. Atypical conditions (atypical ductal hyperplasia (ADH) or atypical lobular hyperplasia (ALH), or a few others) are high risk conditions. Generally the recommendation is monitoring and/or endocrine therapy (a daily pill that reduces estrogen levels). Some women who have atypical breast conditions, usually in combination with a strong family history of breast cancer, do choose to have prophylactic mastectomies. However for most women, the risk is not considered high enough to warrant such major live-changing surgery. Overall, approx. 25%-30% of women diagnosed with ADH or ALH will develop breast cancer within the next 25 years.

Family history of cancer... while a lot of other cancers can be related to the breast cancer, to my knowledge, there is no connection between kidney cancer and breast cancer. And breast cancer is one cousin, and no other family members, would not be considered significant or a risk factor for you. Breast cancer in first degree relatives (parents, siblings) may be significant. Having several second degree relatives (grandparents, aunts, uncles) with breast cancer may be significant. A cousin is a third degree relative. One cousin with a particular cancer, with no pattern of this cancer (or related cancers) in the family, is not significant. 50% of all men and 40% of all women will develop cancer over their lifetimes, so a couple of cases of cancer within an extended family is normal and to be expected. Most cancers are not genetic; only approx. 10% - 15% of breast cancers are thought to be genetic.

As the others have recommended, you need to see a breast specialist and you need to have a risk assessment to get more information about whether or not prophylactic mastectomies are advisable for you. If it is assessed that you are high risk, it may be suggested that you consider having prophylactic mastectomies - but even if you get this recommendation, it's your decision to make. Some high risk women opt for the surgery, others choose to monitor and/or take endocrine therapy to reduce their risk. And if you decide to consider having prophylactic mastectomies, it's your decision to make on whether you would like to go flat, opting for an aesthetic flat closure (a nice smooth chest), or if you would like to have reconstruction. If reconstruction interests you, implants are just one option. There are several different reconstruction techniques and you should talk to one or more plastic surgeons to understand your options and the differences in the techniques.

Having prophylactic mastectomies is not something to do without being absolutely certain that it's what you need and want, and without really knowing what you are getting into. From the information you've provided, it sounds as though you are many steps away from needing to know about types of implants, which is what you've asked about. Please take several steps back to understand first whether this is necessary and whether this is what you want to do. Most of us posting have had this surgery, and we know how that it's not something to go into without fully understanding what's ahead.

Best of luck to you! And please let us know what happens as you investigate the situation more.

Tinasi, if I knew then what I know now, I could have removed both breasts and get over with fear, pain, etc. I wished my doctor would have suggested when by breast was dense and had many cysts.

I had prophylactic mastectomies with direct to implant reconstruction (nipple sparing) in 2014 when I was 34. At the time pre pectoral reconstruction (implants over muscle) was uncommon so mine are under the muscle. Which has been fine for me despite being very physically active, but just be aware the over the muscle is more common now and preferred by many patients and surgeons if you are a candidate. However there are pros and cons to both.

Mine was due to hereditary risk but it was also after years of screening, testing, and deliberation. I actually did quite well with surgery but it WAS a big change. I have limited feeling - only on certain parts of surface and sometimes an unpleasant “twinge” in my right nipple after each surgery. You can see from my signature below I also had a surgery about a year later - that was to replace implants as I was not happy with the rippling - then last November - to take out the anatomical implants due to my own concerns about the rare complication of BIA-ACL (Breast Implant Associated Anaplastic Large Cell Lymphoma) as well as some other issues I had with their comfort - and another tomorrow for fat grafting. So even with immediate implant reconstruction or any reconstruction, there can be future revisions involved.

My recovery went well overall, personally I was off the prescription painkillers and taking long walks within a couple days but I followed all restrictions so it was a while before I got back to yoga, Wright lifting, driving, and all those other things I did before. I had no major complications though but as I said, that does not mean it’s not a significant surgery with risks both from surgery itself or after.

I do recommend not rushing into it. Get a second or even third opinion if you feel you need it - or even if you don’t just to get another brain on it

tinasi, since you have LCIS but don't have breast cancer, if you decide to go ahead with prophylactic mastectomies, you have lots of time to do research on different reconstruction techniques and lots of time to talk to different plastic surgeons. Don't rush into it! The last thing you want are surprises, since most surprises that people have with breast reconstruction are not good ones - it's things they should have been prepared for or warned about in advance.

I had sub-pectoral implant reconstruction with an expander. I would have had a lumpectomy if I'd had a choice but with my diagnosis, that wasn't an option for me. Given that I was so reluctant to have the MX, going flat wasn't something I could face, but that is one option that many woman choose and it's probably the easiest (as in least risk of complications and re-surgeries) way to go. My objective was to look natural and unchanged in clothes. Since sexual sensation and most feeling is lost with reconstruction, I didn't want to affect other parts of my body just to have a more natural feeling and looking (when nude) fake 'breast'. So that's what led me to implant reconstruction. But there are other reconstruction methods, using your own tissue and nerves and body fat, that provide results that are very natural and more similar (from an appearance standpoint) to a real breast.

I found the following graphic on-line from a plastic surgery site, and have doctored it a bit to remove the parts specific to reconstruction after a lumpectomy and reconstruction issues after breast cancer treatment, which can sometimes complicate things versus having a prophylactic mastectomy:

@tinasi:

Sorry did not see your post earlier!

Yes, I have round implants now (Inspira SSM). In my very first surgery I actually got rounds too and switched to anatomicals after about a year due to rippling.

No regrets at all. I was a prophylactic patient so keep in mind my reasoning was to reduce risk in first place so I was not happy with the risk of BIA-ACL and how it seemed the link just got more clear everytime they updated. I never really disliked my anatomicals (though they were some cosmetic defects I grew to accept) but I find the rounds much more comfortable and squishy - not quite like natural breast tissue but closer! On *me* they actually look more natural but that is a personal thing. I did get fat grafting last week to address some of the rippling though as it was still more apparent with the rounds than with the anatomicals, though not as bad as first implants as he went a bit bigger and used a different implant this time

Mine are under the muscle. Back in 2014 pre-pectoral placement was not very common, and at least in the hereditary cancer community it seemed the preference was to go under the muscle anyway unless there were significant concerns with the pectoral muscles in order to make it easier to detect changes in the breast (as any remaining breast tissue would be over the implant, not under it) and reduce the need for the intensive MRI screening many of us in that community were trying to get away from doing regularly by doing PBMX.

I have chosen not to go pre-pectoral in subsequent surgeries as I have not had any issues with them once my muscles relaxed (I am active, I do lift weights, do yoga, kayak, HIIT, run, etc...my push-ups have never quite recovered 100% but I can still do planks, etc). I have little to minimal distortion, they are relatively warm, etc. My PS also preferred for me to keep them under just as I have rather thin skin/tissue so it was better to reduce rippling. I did debate it briefly just as it seemed like it was the newer thing to do, but I just don't want to rock the boat as I have not had issues with them because of their placement, if that makes sense.

My sister on other hand did go pre-pectoral with her PBMX in December 2019. Her PS prefers to go that way, and she lifts very heavy weights so it made sense for her as well to minimize downtime and risk of losing her ability to lift heavy. From comparison, it seemed she had less initial "tightness" than I did as she did not have to deal with her muscles needing to relax, and her implants basically dropped and fluffed out a bit faster than my did, though with a similar frame to mine she does have more rippling; her PS is planning to put bigger implants in and do some fat grafting though to address some of those issues.

@tinasi,

Late last year I underwent a prophylactic bilateral mastectomy, almost 6 years after my LCIS diagnosis which because of my very 'active' fibrocystic breasts led to additional biopsies almost every time I underwent my 6-month imaging. I couldn't tolerate even low dose tamoxifen although that is an excellent risk-reduction option for many women. For these reasons (plus a strong family history) I had a nipple-sparing, direct to implant procedure (round implants placed over the muscle, roughly equivalent to my prior size) with a highly skilled team. One complication I had with this procedure was a scare with nipple necrosis, but in the end everything healed beautifully and I am pleased with the outcome. I do have some rippling on one side for which I may have fat grafting down the line but is really not too bad.