BRCA positive? Can you do a breast augmentation? 5 things to think about.

I just got a call from a young woman who is BRCA positive. She is young. And she knows that she has a 50-80% chance of having breast cancer when she gets older. The question is should she do a breast augmentation? What does she need to think about?

• GET INFORMED ABOUT BRCA. There are different levels of risk within BRCA positive status.  You should understand your risk well before you do any surgery.
  • • I have many blogs on the subject HERE.
    • There are great sites as well: National Breast Cancer Foundation “What to do if you test positive” HERE
    • BreastCancer.Org study on your risk/when you would get an ovarian or breast cancer HERE.
• What age would you do a prophylactic mastectomy? There is a difference between BRCA 1 and BRCA 2. BRCA 1 tends to have an earlier onset. Women have had cancers in their 30s to 40s.  Have you had children? Do you want to breastfeed? How much risk are you okay living with? When would you choose to do it?
• Are you done with kids and breastfeeding? Again, getting to the age issue, if you are close to when your risk starts to skyrocket, should you be doing a simple breast augmentation now? Or would it be better to just do the prophylactic mastectomy, and then the breast augmentation would be a breast reconstruction (and likely covered by insurance).
• Prophylactically treating this is WAY better than waiting for the cancer. Many of these cancers are aggressive, triple negative (therefore harder to treat). If you do a preventative breast removal, you can control the timing, you won’t need chemo or radiation, and you can likely do a nipple sparing mastectomy. Read my blogs on that HERE.
• Implants do impair mammograms.  There was a huge study out of Canada years ago showing delay in breast cancer detection with implants. We know that breast implants impair mammograms more when placed in front of the pectoral muscle, what we call a “subglandular” placement. So if you do choose to do an augmentation, you should place the implant behind the muscle.
• Doing an implant may make later breast cancer reconstruction easier. When we do an implant breast reconstruction on patients who have had a mastectomy, frequently it is a two stage process, with the first stage being a tissue expander to stretch the breast skin to accommodate an implant, followed by a second surgery to place the implant. By doing a breast augmentation when you are young and healthy, you are essentially doing the tissue expander stage early.

This is a complex issue, with lots of psychological ramifications. Everyone has a different level of risk tolerance, anxiety, desire to have babies and breastfeed, and timing issues. There is no right answer.

The good news is you know you are high risk. As tough as that is to know, it allows you to make life decisions being well informed. Have kids earlier. Have prophylactic surgery. Don’t miss that mammogram. Start mammograms early.