October 21, 2026
Each year, nearly 100,000 women in the United States undergo a mastectomy — surgery to remove one or both breasts. Some women have a mastectomy as a preventive measure to reduce their breast cancer risk. Others have one or both breasts removed following a breast cancer diagnosis.
"Having a mastectomy is a significant decision, and for some women with breast cancer, it may be medically necessary," says Ashley Wilbers, MD, an MU Health Care surgical oncologist specializing in breast cancer. "But regardless of why you are removing your breasts, it's important to gather as much information as you can. That way you can make an informed decision about mastectomy and breast reconstruction."
We asked Dr. Wilbers to share the top things she wishes every woman knew when considering a mastectomy:
1. A Mastectomy Does Not Entirely Eliminate Breast Cancer Risk
A mastectomy and a lumpectomy — removing part of the breast — are equally effective for curing breast cancer. While a mastectomy can greatly reduce breast cancer risk by helping to prevent a new breast cancer, risk still exists.
"Even when a bilateral mastectomy (removing both breasts) is done as a preventive measure, it does not take the risk of future breast cancer development down to zero," Dr. Wilbers says. "It may bring your risk down to somewhere between 1% and 3%. It's very low, but it's not nothing."
Dr. Wilbers adds that a mastectomy does not require long-term routine screening mammograms and surveillance like a lumpectomy does. But because risk still exists, you will continue to undergo skin and chest wall exams after a mastectomy with your health care provider, and should be taught how to perform these exams at home to monitor yourself.
2. The Decision to Have a Bilateral Mastectomy Is Typically Patient Preference
If you are having a breast removed due to a breast cancer diagnosis, you'll be faced with deciding whether to have a single (one breast) or bilateral (both breasts) mastectomy. The removal of the second breast is often not necessary for treatment. But it does reduce the risk of a second breast cancer. Reconstructing both breasts can also result in better symmetry compared to reconstructing one breast only.
However, removing both breasts adds time to the surgery and may not be safe for people with other serious health conditions. In that case, your surgeon may recommend against a bilateral mastectomy for your safety.
If you are considering a mastectomy because you have a genetic predisposition for breast cancer or are found to have a high risk for breast cancer based on your individual risk factors, removing both breasts is the recommendation in order to have the lowest possible future cancer risk. But a mastectomy is not your only option. Some women choose to do high risk screening, which typically involves adding a breast MRI in addition to their annual mammogram. This helps increase the likelihood of catching a cancer as early as possible but doesn’t prevent cancer from developing.
Other preventive options include:
- Lifestyle modification, which includes getting regular exercise, maintaining a healthy weight, avoiding processed foods and added sugars, sticking with leaner proteins instead of red meat, eliminating or minimizing alcohol intake and not smoking
- Chemoprevention, which involves taking hormone-blocking medications for five years to lower your risk of breast cancer
"I always encourage high-risk women to come for multiple visits before making a decision," Dr. Wilbers says. "You need to be prepared for every possible way that a mastectomy can impact your life. We can educate you and make recommendations, but in the end, it is your decision."
If you aren't sure of your breast cancer risk, visit the High-Risk Breast Clinic at MU Health Care. If you have a mother, sister, daughter or aunt who had breast cancer, you can come for screening without a referral.
3. You May Need Cancer Treatment Following a Lumpectomy or Mastectomy
Removing the cancerous tissue or breast through breast cancer surgery does not necessarily mean you won't need treatment after your procedure. Most lumpectomies are followed by radiation therapy. Chemotherapy is possible following either lumpectomy or mastectomy, and you may not know if you need it until after your procedure.
"What you are really comparing is a lumpectomy-plus-radiation versus a mastectomy," Dr. Wilbers says. "The need for chemotherapy has nothing to do with which surgery you have. We make that decision based on the tumor's biology and lymph node involvement — information we don't have until after the procedure."
Certain types of breast cancer are more likely to require chemotherapy. The tumor will also be tested to understand the risk of your cancer coming back in another area of the body (metastasizing).
4. Not Everyone Is a Candidate for Nipple-Sparing Mastectomy
For many women, preserving the natural look and feel of their breasts is a priority. Nipple-sparing mastectomy is one way to do that. The nipple and areola are preserved during the mastectomy instead of being removed.
However, nipple-sparing mastectomy is not appropriate for all patients. Cancer outcomes always come first, and in some situations, there is an increased risk of the nipple not surviving the surgery. For instance, if the cancer is located directly behind the nipple, removing the cancer may compromise the blood supply to the nipple and areola or may risk not removing all the cancer during the first surgery. The size of the breast may also make someone a less ideal candidate for this surgery.
If sparing the nipple is not an option, your surgeon may be able to reconstruct a nipple from your skin. 3D nipple tattooing after reconstruction is also possible.
"Surgeons work with their plastic surgery colleagues to give you a good idea of what your options are, what you can expect for scar placement and the long-term cosmetic outcome," Dr. Wilbers says.
5. Breast Reconstruction Does Not Always Involve Implants
Women have many options for breast reconstruction following a mastectomy. Those options are highly dependent on your anatomy, health status and personal preference.
The options for breast reconstruction include:
- Aesthetic flat closure: The surgeon reconstructs the chest wall to restore a natural contour.
- Autologous-based reconstruction: The breast is reconstructed during a complex surgery using the patient's own tissue — typically taken from the abdomen or back.
- Goldilocks mastectomy: For women with larger breasts (D-cup or larger), tissue may be taken from the lower portion of the breast and used to either rebuild the chest wall contour or reshape into a small, recognizable breast mound — the size of an A- or B-cup breast.
- Implant reconstruction: Breasts are rebuilt using saline or silicone implants.
On some occasions, more than one technique may be used, such as both natural tissue from the back and an implant.
"Many people are not familiar with the Goldilocks mastectomy," Dr. Wilbers says. "But for appropriate patients who do not want to have a full reconstruction, it is an excellent option."
6. Choosing the Right Breast Cancer Team Is Critical
The choice to surgically remove your breasts is deeply personal. An expert breast cancer team can personalize your options and support you in the decision process.
Beyond surgical expertise, look for a medical team that offers preoperative counseling and enhanced recovery protocols. A protocol like MU Health Care's TIGER Protocol provides preoperative information and services, including:
- Medication management
- Pain control before surgery (to reduce the drugs needed after surgery)
- Preoperative and postoperative physical therapy (PT) sessions
- Preoperative nutrition
"This surgery cannot be undone," Dr. Wilbers says. "It's vital to have multidisciplinary support every step of the way, from preoperative counseling to postsurgical PT and support groups. Your care team's priority should be curing or preventing breast cancer. But they should also be dedicated to providing the best cosmetic and psychosocial outcomes as humanly achievable."
Next Steps and Useful Resources
- At an increased risk for breast cancer? Learn more about our High-Risk Breast Clinic.
