Opting for Bilateral (Double) Mastectomy

A bilateral (double) mastectomy is the surgical removal of both breasts to treat or prevent breast cancer. In some cases, it is a necessary procedure—such as when an advanced cancer is found in both breasts simultaneously. In other cases, a woman may choose to have both breasts removed at the same time even though it is not considered medically necessary.

Reasons for Choosing a Bilateral Mastectomy

There are some cases where a bilateral mastectomy is the only option for effective breast cancer treatment. More commonly, however, people opt for a bilateral mastectomy for other reasons.

When a breast is removed for reasons other than cancer, the terms used are risk-reducing mastectomy (RRM) or prophylactic mastectomy. For example, a person has breast cancer in the right breast and has chosen mastectomy for surgical treatment of her right breast cancer. They have also chosen mastectomy of the left breast, and this is known as contralateral prophylactic mastectomy.

Women who have a bilateral mastectomy may do so because of any one of the following:

Testing Positive for BRCA1 or BRCA2 Gene Mutations

In women who are found to carry the BRCA1 or BRCA2 gene, the risk of developing breast cancer over their lifetime is very high. For this reason, the person may choose to proceed with bilateral prophylactic mastectomy, reducing their risk of developing breast cancer by about 95%.

Fear of Recurrence in the Other Breast

A 2017 study found that the rate of women who opted for a CPM after being diagnosed with invasive cancer in one breast tripled from 2002 to 2012, despite the fact that previous research found no improvement in survival among women who had both breasts removed compared with those who only had the affected breast removed.

In fact, the vast majority of breast cancer survivors do not go on to develop a new breast cancer in the other breast. Furthermore, any potential decrease in risk resulting from CPM does not decrease the possibility of the primary breast cancer metastasizing elsewhere in the body.

Wanting Reconstructed Breasts to Match

Women who have one breast removed may prefer to have both removed if they are going to choose breast reconstruction. It may be hard to achieve symmetry if only one breast is removed; breasts may "match" better if both are reconstructed at the same time.

Breast Cancer Is Advanced

Cancer that is advanced enough to warrant a double mastectomy is very rarely found in both breasts simultaneously. That said, it is a possibility.

Recovering From Surgery

Having one breast removed, depending on the type of the procedure, typically takes two to three hours; having both breasts removed will take four to six hours. (If reconstruction is done at the same time, it will take longer.)

Likewise, recovering from a bilateral mastectomy is comparable to recovering from a unilateral mastectomy, except that your risk for complications, such as infection, is doubled.

You will have surgical drains on both sides instead of one, and it will take longer for you to fully recover and resume your normal activities.

Post-surgical side effects and complications include:

• Fatigue: Many people feel tired for days or weeks after the surgery.
• Pain and stiffness in the arms: The shoulders and arms may be stiff, sore, or otherwise uncomfortable. Medications and exercises can reduce these symptoms.
• Infection: It is very important to keep your wounds clean and care for your surgical drains properly while recovering.
• Phantom feelings: Phantom breast pain or numbness can occur after a mastectomy. Prescription medications can often alleviate these symptoms.
• Lymphedema: Treatment of breast cancer often involves the removal of lymph nodes at the time of surgery for proper staging and treatment. This can result in swelling of the arm, known as lymphedema; in some cases, this can be permanent.

A Word From Verywell

If you are considering a bilateral mastectomy, be sure to give yourself time to think through both the medical facts and your reasons for making the choice to have both breasts removed.

Know, too, that while insurance companies that offer mastectomy coverage must also provide coverage for reconstructive surgery after mastectomy, the CPM should also be covered due to the Women's Health and Cancer Rights Act of 1998, which requires "surgery and reconstruction of the other breast to produce a symmetrical appearance."