Some women who are at high risk for breast cancer may elect to undergo prophylactic mastectomy. This procedure can reduce the risk for cancer by 90% (Hartmann et al., 1999; Meijers-Heijboer, van Geel, van Putten et al., 2001), so a more appro-priate term for this surgery is “risk-reducing” mastectomy. The procedure, performed by a breast surgeon, consists of a total mastectomy (removal of breast tissue only). Possible candidates are women with a strong family history of breast cancer, a diag-nosis of LCIS or atypical hyperplasia, a diagnosis of BRCA-1 or BRCA-2 gene mutation (see following discussion), an extreme fear of cancer (“cancer phobia”), or previous cancer in one breast. Many women opt for immediate reconstruction with the mastectomy.
The woman needs to understand that this surgery is elective and not emergent. To be sure that she understands the implica-tions of surgery, the woman should be offered a consultation with a plastic surgeon, a genetic counseling session, and a psychologi-cal evaluation. Women who make an informed decision tend to demonstrate more satisfaction with the cosmetic results (Rowland, Desmond, Meyerowitz et al., 2000).
Nursing interventions for the woman considering a risk-reducing mastectomy include ensuring that the patient has in-formation about reconstructive options and providing referrals to the plastic surgeon, genetic counselor, and psychological coun-selor. Many women need time to think over the procedure, and the nurse can be helpful in answering questions about the proce-dure and its implications and in assisting the patient to decide whether the surgery is an appropriate option. The woman con-sidering this option may wish to talk with a woman who has had the procedure.