Elective Second Mastectomy

Dear Dr. Bone,

I just celebrated 5 years out from my breast cancer. I had a mastectomy and implant reconstruction with a matching augmentation implant to the other side for symmetry. This week I had a suspicious mammogram on my remaining real breast. I am a wreck waiting for the biopsy. I don’t think I can go through it all again. Do you think the surgeon would be wiling to remove my breast regardless of the biopsy result? I think it will be the only way I will sleep peacefully.

Anxiously waiting,
Jupiter

Dear Anxious,

If only I had a penny for every patient in your shoes...Your situation is not unusual. There is no question that the prospect of having another cancer is almost unthinkable. The good news is that statistically it should not be a cancer. My advice is to take it one day at a time and not try to predict your reaction ahead of time. If you wish to have a mastectomy regardless of the biopsy results, you should discuss it with the surgeon. As I have mentioned many times, I have never heard a woman regret that she had bilateral mastectomies, only that she didn’t! If your insurance company does not feel that it is a procedure they want to pay for, you will need to address that issue. The cost-benefit analysis would seem to fall in favor of the surgery over years of imaging with follow-up extra views, sonograms, MRIs, and even biopsies. Should you get a second cancer, it would then be very costly for your insurer to pay for surgery, radiation therapy and/or chemotherapy. Having said all that, it can be tough to convince some insurance companies that they should pay for the prophylactic surgery.

Good luck.
Dr. Bone