Is Double Mastectomy the Right Choice for You?

Receiving a breast cancer diagnosis is overwhelming—the fear, anxiety, and uncertainty can feel unbearable. If you're facing this situation, you might be wondering, “Should I have both breasts removed to prevent cancer from coming back?”

You’re not alone in considering this option. An increasing number of women who are younger than 40 at the time of diagnosis are choosing to have a double mastectomy—a surgical procedure to have both breasts removed—even if they have early-stage cancer in just one breast.

But is double mastectomy always the right choice? Let’s explore what medical experts want you to know.

A double mastectomy, also called bilateral mastectomy or contralateral prophylactic mastectomy (CPM), is the surgical removal of both breasts at the same time. The term prophylactic means the procedure is preventive, done to prevent a new cancer rather than treat an existing one.

Double mastectomy is an aggressive treatment option and comes with a higher risk for complications such as pain, numbness, and infection, as well as lymphedema (arm swelling if lymph nodes are removed).

One thing that is important to know: Neither a single nor a double mastectomy is 100% effective at reducing the risk of breast cancer recurring, since it’s not possible to remove every single breast cell.

“Removing a healthy breast does not help a woman live longer,” says Rachel Greenup, MD, MPH, chief of Breast Surgical Oncology at Smilow Cancer Hospital.

Almost 50 years of medical research shows clear trends, Dr. Greenup says. Survival rates are the same whether you have one or both breasts removed, cancer recurrence risk in the unaffected breast is extremely low (less than 0.1% to 0.5% per year), and overall cancer recurrence risk isn’t reduced by removing the healthy breast.

The American Society of Breast Surgeons consensus statement states that surgeons should not routinely perform a double mastectomy for average-risk patients with cancer in only one breast without providing women with complete, understandable information about the "generally low risk" of developing cancer in the unaffected breast.

And yet, double mastectomies tripled in the 10 years between 2002 and 2012, according to research published in 2017. (Data to show surgical trends can be several years behind, but some research has shown that the numbers may have stabilized since then).

But doctors are still concerned that too many women are opting for surgery they don’t need, says Dr. Greenup. This includes women who don’t have early-stage cancers or cancers that are not hereditary. “It is understandable to feel anxious when you are in your 30s and diagnosed with cancer. Hearing you have cancer is traumatic for anyone at any age.” But it’s still important for young people to get all the facts about their particular disease, she says.

For women with BRCA1 or BRCA2 gene mutations—which significantly raise the risk of cancer—a double mastectomy may be medically recommended, since it has been shown to reduce cancer risk in the unaffected breast by 90-95% for this high-risk population. However, the procedure does not reduce the overall risk of cancer returning, either in the breast or another part of the body. Instead, it reduces the risk of a new breast cancer developing, in this population of individuals genetically predisposed.

There are other situations where a double mastectomy may be recommended. Those include a diagnosis of cancer in both breasts; a strong family history of breast cancer; or a history of radiation to the chest, perhaps as a treatment for lymphoma.

Most experts do not recommend bilateral mastectomy to women who are diagnosed with advanced breast cancer that has already spread, as removing the primary breast cancer doesn’t change the survival outcomes.

Fear and anxiety are two main reasons, Dr. Greenup says. “Young women will say, ‘I never want to go through this again. I never want to hear that I had an abnormal mammogram, be called back for a biopsy, or have wait for results,’” she explains.

This reaction is completely understandable. “But surgery is not a cure for worry related to cancer,” she says.

Many women say they prefer a double mastectomy so they can look forward to peace of mind once they complete their treatment, Dr. Greenup says. However, early research shows that average-risk women who have both breasts removed don’t experience significantly different peace of mind compared to those who have single mastectomy or lumpectomy with other treatments.

Additionally, some experts still cite what they call “the Angelina Jolie factor,” which experts say had a global effect on women’s choices. In 2013, the actress, who didn’t have a breast cancer diagnosis, spoke out about her choice to have a double mastectomy after learning that she had a known BRCA mutation. In Jolie’s case, the choice made sense. “She had a lifetime risk of breast cancer up to 80%,” says Dr. Greenup.

When women consider a double mastectomy, the decision goes beyond surgery itself. It also involves thinking about how the procedure may affect their sense of self and quality of life in the long run, says Siba Haykal, MD, PhD, chief of reconstructive oncology for Yale Medicine.

”It's about what breasts represent to women, including sensation,” she says. “What matters most is each woman’s sense of self, their appearance, and the way their clothes fit. Losing both breasts can impact their mental health and quality of life.”

There are also financial implications. Dr. Greenup has studied the economic burden of breast cancer treatment and found women who chose to have both breasts removed, followed by reconstruction, were more likely to experience higher incurred debt, significant financial burden, and changes to employment—likely related to prolonged recovery time.

Dr. Haykal emphasizes that women should make decisions about mastectomy in consultation with their breast surgeon before consulting a reconstructive surgeon. At the same time, an understanding of the choices can help, she says.

Breast reconstruction may be performed to rebuild one or both breasts using synthetic implants or a flap of the patient’s own tissue, with blood vessels, skin, and fat. In the latter case, tissue is usually taken from the abdomen and then reattached to the area where the breast was removed using microsurgery, such as in a deep inferior epigastric perforator (DIEP) flap surgery. Flap surgery can only be performed once, so women who choose a single mastectomy should know they may not have that option again if cancer develops later in the other breast, Dr. Haykal says.

No matter the approach, reconstruction does not restore breasts exactly as they were before. For women who have a double mastectomy, it can be easier to create symmetry between the two reconstructed breasts. But there can also be good results after one breast is removed with additional surgery to lift and match the unaffected breast, Dr. Haykal says.

Mastectomy can lead to a loss of sensation in the breast that can’t be fixed with reconstruction—and a double mastectomy means that loss will affect both breasts. Some describe the feeling as numbness or no sensation at all. “This can impact sexual sensation and can even make everyday experiences, such as hugging a family member, feel different,” Dr. Greenup says.

Surgeons performing breast reconstruction may be able to perform nipple-sparing surgery. They may also be able to preserve some sensory branches that are supposed to go to the nipple and connect them to a few pieces of nerve underneath the nipple, Dr. Haykal says. (A sensory branch is a nerve fiber that carries sensations like touch to the brain.) “But the sensation won’t come back as normal—it will not be an erogenous sensation, which is really the sensation that we’re hoping to bring back,” she says.

For women who experience sexual dysfunction after breast cancer treatment, Yale Medicine’s Sexuality, Intimacy, and Menopause Program combines both medical and psychological care to address these challenges.

After treatment for an early onset breast cancer, patients are closely monitored for recurrence in the remaining breast or elsewhere in the body. “We continue to take your health very seriously,” Dr. Greenup says.

It’s true that most women who choose a double mastectomy will not need mammograms again. However, women at higher risk of recurrence may still be monitored with breast MRI, ultrasound, or both.

Those who have a lumpectomy plus radiation on one breast will need a new baseline mammogram about six months after the radiation, followed by annual screenings. Women who choose a single mastectomy continue to need an annual mammogram on the remaining breast. If your doctors think you’re at high risk of recurrence, they may recommend additional screenings with breast MRI, ultrasound, or a combination of these tests.

The Smilow Survivorship Clinic at Smilow Cancer Hospital helps women navigate recovery and long-term follow-up. The clinic provides individualized care plans to support ongoing recovery, including nutritional counseling and exercise guidance, drawing on evidence-based recommendations from organizations such as the American Cancer Society.

Clear communication is key, says Dr. Greenup, whose research focuses on “shared surgical decision-making,” which means the surgeon and the patient work together to choose the best treatment option. She is part of a multisite study (“CONSYDER”) testing a web-based tool designed to give patients accurate information about treatment differences and make choices that are best for achieving “peace of mind” after treatment.

“We are asking women what drives their decision-making and where they are getting their information,” she says. Many women report being influenced not only by their doctors, but also by friends and acquaintances, online content, and social media. This is not always in their best interests. “There is a lot of misinformation out there, and it can be really powerful,” Dr. Greenup says. “A patient might spend an hour with her surgeon reviewing all the science, but stories from women in her community may influence her personal decision.”

It’s normal to feel uncertain, and doctors encourage patients to voice every question or concern. “I rarely refuse a bilateral mastectomy if that's what a patient truly believes is the right choice for her,” Dr. Greenup adds. “But I make sure she understands exactly what the extra surgery may mean for her life in the short and long term.”

Even after gathering all the facts, some women still feel unsettled, says Nancy Borstelmann, PhD, MPH, LCSW, co-director of the Early Onset Cancer Program at Yale Cancer Center and Smilow Cancer Hospital. “When people are casting about for more opinions, it suggests that an underlying level of uncertainty may be there,” Borstelmann says. “That uncertainty can show up as intrusive thoughts, rumination about what choice to make, or an ongoing sense of doubt despite gathering more information,” she explains.

Borstelmann says it can help to get it all out on the table. “There is real value in getting out of your own head, and, if possible, talking it through in more detail with someone you trust to listen to what is on your mind.”

Talking it through with someone impartial—such as a therapist or counselor—can also help. “Discussing your concerns with somebody who isn’t your family or a friend and is not invested in it in the same way can help you clarify the pros and cons, the evidence, and your feelings and your priorities—and ultimately help you make the choice that makes sense for you.”