Prophylactic surgery is a type of surgery performed as a preventative measure rather than to fix an existing problem. The most common types are mastectomies to prevent breast cancer and hysterectomies to prevent cancers of the uterus and reproductive organs. Surgeons may also recommend prophylactic surgery for other potential conditions.
Genetic researchers have isolated several genes that, when altered, increase the risk of developing ovarian and breast cancer. The overall risk of a woman developing breast cancer is about 12 percent. That risk is about five times higher for women with altered “breast cancer genes.” Not every woman with the altered genes will develop breast cancer, and not every person with breast cancer has those altered genes, so they are not the defining factor for the disease. Women who do have the altered genes may opt for prophylactic surgery to remove the breasts. Removing both of the breasts before cancer develops can reduce the risk of developing breast cancer by up to 90 percent.
Women at a high risk for ovarian cancer, either due to the presence of the altered genes, or due to past medical conditions such as human papillomavirus disease may undergo prophylactic surgery to remove the reproductive organs. Doctors typically do not recommend a prophylactic hysterectomy unless abnormal or precancerous cells are found during a routine pap smear. While some women are able to have a partial hysterectomy that leaves the ovaries in place, avoiding the need for hormone replacement therapy, prophylactic hysterectomies typically remove the entire uterus, cervix and ovaries.
There are numerous factors to consider before deciding to undergo prophylactic surgery. Women considering a mastectomy may want to speak with a plastic surgeon prior to the procedure to determine if breast reconstruction can be performed at the same time or immediately after the mastectomy. An altered sense of body image can occur in post-mastectomy patients; having a good support system can help ease the transition period after the surgery. Those undergoing a hysterectomy will need to consider whether they want to use hormone replacement therapy after surgery.
The risks of prophylactic surgery are also a major consideration. Any time a patient is sedated with general anesthesia, there is a small risk of complications, include respiratory depression, coma and death. Post-operative infections of the surgical incisions can occur, as can excessive bleeding and prolonged recovery time. In rare cases, damage to the nearby organs can occur, leading to additional complications.
Cost is also a consideration, as some insurance policies do not cover prophylactic surgery. Patients should talk to their policyholder, as certain conditions may need to be met even for those companies that do cover the surgery. Those considering prophylactic surgery should talk to their doctors about all the risks and benefits before making a final decision.
