Prophylactic mastectomy

Jane is 55 years old. She recently noticed an area of lumpy tissue in the outer part of her right breast.

Mammography, ultrasound and a fine needle biopsy did not show any suspicious features. The assymmetric lumpy area was excised.

Histology showed fibrocystic tissue. There was a coincidental finding of lobular carcinoma in situ within the specimen. This histological finding is associated with an increased risk of invasive breast cancer developing in the future. The risk applies to both breasts.

Management options include:

1. Careful surveillance with regular 6 monthly ultrasound and annual mammography.
2. Prophylactic Tamoxifen.
3. Prophylactic mastectomy and reconstruction.

After careful deliberation Jane elected to have bilateral prophylactic skin sparing mastectomy and immediate TRAM flap reconstruction. She made a good recovery after surgery.

One year later the nipples were reconstructed.

Jane is very satisfied with the cosmetic result of her surgery.