CNN / QUESTION & ANSWER
“I had breast reduction surgery two years ago and went from a size GG to DD. I wanted to know, does a reduction lower the risk of breast cancer or abnormalities in the breast?”
Asked by Allena, North Carolina
Answer by Dr Otis Brawley, Chief Medical Officer, American Cancer Society
updated September 14, 2011
Thanks for a fascinating question. Breast removal to decrease risk of breast cancer has become common among women at high risk for breast cancer because of a previous personal history of breast cancer or a genetic predisposition to the development of breast cancer.
The medical name for the procedure is "bilateral prophylactic mastectomy." In this procedure almost all of a woman’s breast tissue is removed. It is technically difficult to remove all of the breast tissue without significant postoperative complications such as swelling of the arm.
There is solid evidence that bilateral prophylactic mastectomy reduces the risk of breast cancer in women with a strong family history. It has been estimated that the risk is reduced by up to 90%. It does not reduce the risk of breast cancer to zero and indeed I have personally cared for several women with breast cancer diagnosed years after a prophylactic mastectomy.
After breast reduction surgery, a substantial amount of breast tissue remains. A cancer can develop in this tissue. A woman who has had this procedure should continue regular screening and surveillance for breast cancer according to common guidelines.
The American Cancer Society (for whom I work) recommends that women of normal breast cancer risk in their 20s and 30s practice breast awareness.
This means, be familiar with your breasts and seek a doctor’s advice if you feel any abnormality. The old "monthly breast self-examination" is not really advocated today; instead, there’s "breast awareness," which is really a more brief daily examination of one’s breasts.
These women should also get an examination from a skilled health care provider every three years or so. Every year, women over 40 should get a good high-quality mammogram and a clinical breast examination from a skilled health care provider while maintaining breast awareness.
There may be an advantage in breast reduction surgery in that a woman and her health care provider might be better able to appreciate a breast mass. Some but not all women who have breast reduction surgery will have some scarring of breast tissue that makes the interpretation of mammograms more difficult.
These women will benefit from mammography at a breast center that has previous post-surgery mammograms for comparison