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Q. Hi. I had implants placed at age 19 only to find out my grandmother was diagnosed with breast cancer at age 40. I had my first mammogram and was told I have dense breast tissue, which further increases my risk. Would I be able to do a preventative mastectomy?

Thanks for your question. Many insurance companies cover preventative mastectomy, and it’s not uncommon. There are specific medical policy requirements that a patient has to meet to qualify – having a family history, like your grandmother, being diagnosed at a young age may satisfy one of the requirements. If you would like to provide your insurance company info, I’m happy to search their medical policies and see what I can find for you. There are risk models that we can put your information into and find out what your percentage of risk is currently. We could chat sometime today via telephone, and I can get a quick medical history to help see if you might be a candidate. My direct line is 843-849-8418. Hope to hear from you soon.

– Gail Lanter, CPC Practice Manager

A: Hi. Thank you for your question. I am sorry to hear your grandmother was diagnosed with breast cancer. You have a good question that many other women in a similar situation might have as well. The decision to have a preventive mastectomy should be based on the risk of getting breast cancer, combined with the risk reduction of a preventive mastectomy.

In other words, if your risk was a lot greater than the average woman’s risk, then you might consider preventive mastectomies depending on how much higher your risk was. Many different factors determine the risk. Having a grandmother with breast cancer may not be a major factor in your situation. Regarding family history, it is usually having a mother, daughter, or sister with breast cancer that is more of a factor than a grandmother.

There are also other factors that can be important as well. We are learning more all the time about risk factors for breast cancer. As a plastic surgeon, I am an expert in the field of rebuilding the breast but not an expert in cancer treatment or mastectomy surgery to remove cancer. We have many patients who have preventive mastectomies because of high risks, but we have a specialized breast surgeon do the mastectomy, and we do the reconstruction.

To determine your risk, you should be seen by a breast surgeon who specializes in breast cancer surgery. A breast surgeon can calculate your risk-taking into consideration your family history as well as all of the many other factors that may contribute to your risk. Having dense breasts or breast implants does not generally directly increase your risk of getting breast cancer. Having dense breasts may make it harder to have a mammogram, but in general, that alone is not an indication to have a mastectomy.

Women have mammograms to find breast cancer or pre-breast cancer early, but a mammogram does not reduce the chance of getting breast cancer. If you would like to be seen by your grandmother’s breast surgeon, I’m sure they can help you determine what your risk may be. If you would like a referral to one of the breast surgeons we work with let me know, and we can make a referral for you. If you are concerned about any problems you may have regarding your breast implants and cannot return to your original plastic surgeon, let me know I would be glad to help.

I hope that I answered your question. Please let me know.

– Dr. James Craigie