Prophylactic breast mastectomy

Breast cancer is the most frequently diagnosed cancer among women in Poland and worldwide, with over 21,000 Polish women diagnosed each year. For most, the fight against the disease begins the moment a tumor is detected. However, some women decide to act earlier—before the cancer even appears. They choose preventive mastectomy—a radical procedure that evokes emotions and questions: Is this brave or hasty? Does it truly save health, and perhaps even life?

Dr. Krzysztof Kozak, MD, an oncological surgeon, talks about who is eligible for peace and health, what the decision-making process looks like, and why not only medical facts but also emotions are important in this conversation.

We're hearing more and more about so-called preventive mastectomies, especially after celebrities like Angelina Jolie publicly admitted to having them. What is a breast mastectomy?

A preventive mastectomy, or more accurately, a cancer risk , is the surgical removal of both breasts in healthy women who do not have cancer but are at high risk. The primary goal is to significantly reduce the risk of developing breast cancer—research shows that such a procedure can reduce the risk by as much as 90–95%.

Who qualifies for this surgery?

Genetic and familial factors are key here. The most common indication is the presence of BRCA1 or BRCA2 gene mutations, which increase the lifetime risk of developing breast cancer by approximately 87%. The second group includes women with a strong family history—for example, a mother, sister, or grandmother who had breast cancer at a young age.

Should every woman with a BRCA mutation immediately decide to have a mastectomy?

Absolutely not. It's always an individual decision. Before a patient is qualified for surgery, they undergo comprehensive diagnostics and consultations—genetic, psychological, and oncological. Some women choose intensive monitoring in the form of breast imaging tests every six months. Others, especially after having children or with a strong family history, consider surgery as a way to relieve constant anxiety.

What are the most common concerns of patients?

Most often, they fear loss of femininity and changes in their body image. Not every patient is ready for surgery, even knowing it reduces the risk of disease. That's why the opinion of an oncology psychologist and discussions in support groups are so important. Another issue is the issue of complications—infection, healing problems, loss of sensation, or the need for further corrective procedures.

Does a preventive mastectomy mean that a woman is completely safe?

Unfortunately, no. No procedure offers a 100% guarantee. Even after a complete breast removal, a minimal amount of glandular tissue remains, where—theoretically—cancer could develop. However, the risk of developing breast cancer is reduced to approximately 5-10%

Is the treatment reimbursed in Poland?

Yes, for several years now, the National Health Fund has been reimbursed for prophylactic mastectomy with simultaneous reconstruction. Patients eligible for the procedure include:

• a mutation in the BRCA1/BRCA2 gene was detected and confirmed twice;
• have a positive family history, i.e. two cases of the disease in first- or second-degree relatives before the age of 50, or three cases of the disease at any age, including the patient;
• metachronous or synchronous breast cancer has been diagnosed in first-degree relatives;
• the presence of a proliferative disease with cellular atypia was confirmed.

What would you like to say to women who are facing the decision to have a preventive mastectomy?

Above all, you are not alone. This is a decision that requires time, discussions with experts, and support from loved ones. There is no single right choice – both intensive monitoring and mastectomy are good options if they are consciously and thoughtfully implemented.

Thank you for the interview.