Risk Reducing Mastectomy (RRM)
Women at a high-risk of developing breast cancer without a personal history of breast cancer may choose a double mastectomy known as Bilateral (left and right) Risk Reducing Mastectomies (BRRM). This to reduce their risk of developing a subsequent breast cancer. The aim is to remove as much of the breast tissue as possible. In reality, it is not possible to remove every single breast cell and in general, in excess of 90% of the breast tissue is removed at time of BRRM. This reduces the risk of developing a subsequent breast cancer by 85-95%. There is a 81-100% survival benefit from breast cancer related mortality
Interestingly, uptake of BRRM varies from country to country (international variation). Th highest rates are seen in the UK and Netherlands (33-50%) and the lowest rates in Israel and Poland (3-4%). Multiple factors contribute to this variation including cultural beliefs, access to genetic testing and healthcare systems. Media coverage of Angelina Jolie’s decision to have BRRM for her BRCA1 mutation resulted in almost a doubling of uptake of BRRM and referrals to UK genetic units.
BRRM is associated with reductions in breast cancer anxiety and psychosocial well-being. There are varying effects on body image and sexual well-being, which need careful counselling.
