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Risk-Reducing (Preventive) Mastectomy in Los Angeles
Reviewed by Elizabeth Arena, MD, FACS.
Dr. Elizabeth Arena, a breast surgical oncologist in Los Angeles, performs risk-reducing (preventive) mastectomy for women with a BRCA1 or BRCA2 mutation, a strong family history or another reason for a high lifetime risk of breast cancer. She removes healthy breast tissue to lower that risk. For women who choose screening instead of surgery she orders and reviews their yearly MRI and mammograms.
What is a prophylactic (preventive) mastectomy?
A prophylactic mastectomy, also called a preventive, preventative or risk-reducing mastectomy, is an operation to remove healthy breast tissue from a woman at high risk, to lower her chance of developing breast cancer. It takes two forms:
- Double (bilateral) prophylactic mastectomy: Dr. Arena removes the tissue from both your breasts when you have never had breast cancer. This is the usual form.
- Contralateral prophylactic mastectomy: she removes the tissue from your other, healthy breast during surgery for cancer in one breast.
If you have cancer in one breast but no inherited mutation and no strong family history, your chance of a new cancer in the other breast is usually low. Removing that breast has not been shown to help women in this group live longer. [1] Dr. Arena estimates the risk in your other breast from your genetic result and your family history. For the operation on your breast with cancer, see breast cancer surgery.
Who should consider a preventive mastectomy?
A preventive mastectomy is meant for women whose lifetime risk of breast cancer is high, most often because of an inherited gene mutation. For women at average or slightly raised risk, the American Cancer Society says the operation is generally not a good option. [1]
- A BRCA1 or BRCA2 mutation: the most common reason women have the operation.
- Another high-risk gene mutation: such as PALB2, TP53, PTEN or CDH1.
- A strong family history: several close relatives with breast cancer, especially if they were diagnosed before 50, even when your own genetic test is negative.
- Radiation to your chest before age 30: most often given for Hodgkin lymphoma.
- Lobular carcinoma in situ (LCIS): abnormal cells in the milk glands that are not cancer but raise your risk, especially alongside a strong family history.
In her high-risk breast program, Dr. Arena calculates your lifetime risk from your family history and any genetic result. She takes the blood or saliva sample for genetic testing in her office. The result usually comes back before you choose an operation.
A BRCA mutation also raises your risk of ovarian cancer, so Dr. Arena refers you to a gynecologic surgeon to discuss removing the ovaries and fallopian tubes.
Should you choose surgery or screening?
Screening does not lower your risk: the yearly MRI and mammogram are there to show a cancer while it is small and easier to treat. A preventive mastectomy lowers the chance that a cancer forms at all. Medication that lowers or blocks estrogen can be added to screening, although for BRCA carriers it is not yet clear that it prevents breast cancer. [2]
| What changes | Screening | Preventive mastectomy |
|---|---|---|
| What it involves | A breast MRI and a mammogram each year, about six months apart, with breast exams | An operation, with reconstruction at the same time or later, or an aesthetic flat closure |
| Your risk of breast cancer | Unchanged; the aim is to find a cancer early | At least 95% lower with a BRCA1 or BRCA2 mutation; up to 90% lower with a strong family history [3] |
| Extra scans and biopsies | Call-backs for more images, or a biopsy, whenever a scan shows an abnormal area | Frequent screening scans and call-backs stop |
| Breastfeeding | Not affected | No longer possible |
| Feeling in your breasts and nipples | Not affected | Usually reduced or lost |
| Can it be undone? | You can switch to surgery at any point | No |
Which type of mastectomy can you have?
The type that suits you depends on the size and shape of your breasts, the position of your nipples, whether you want reconstruction and whether you want your nipples removed as well.
| Operation | What Dr. Arena removes | What you keep |
|---|---|---|
| Total (simple) mastectomy | All the breast tissue, your nipple and the areola (the darker skin around it) | Your chest muscle and the lymph nodes under your arm |
| Skin-sparing mastectomy | The breast tissue, nipple and areola, through a smaller incision | Most of your breast skin, which the plastic surgeon uses for reconstruction |
| Nipple-sparing mastectomy | The breast tissue from behind the skin and nipple | Your skin, nipple and areola |
| Nerve-sparing mastectomy | The breast tissue, taken out around the nerves that supply your chest skin and nipple | Those nerves, so your skin and nipples may keep some feeling |
| Aesthetic flat closure | The breast tissue and the extra skin | A smooth, flat chest, without reconstruction |
Removing your nipples takes out a little more breast tissue, which lowers your risk slightly further, while keeping them usually gives a more natural-looking result after reconstruction. [3]
If you want reconstruction, the plastic surgeon you work with reconstructs your breasts with implants or your own tissue. Most women have it in the same operation, starting as soon as Dr. Arena has removed the breast tissue and while you are still under anesthesia. You can also have reconstruction months or years later, or choose a flat closure and no reconstruction at all.
What happens during surgery and recovery?
You are under general anesthesia for the whole operation. Recovery usually takes several weeks and it can take a few months when your breasts are reconstructed in the same operation. [4]
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Incisions and tissue removal
Dr. Arena plans each incision before surgery and places it where it will be least visible, such as the fold beneath your breast or the edge of the areola, then removes the breast tissue through it.
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Pathology report
A pathologist examines all the tissue under a microscope. Occasionally it shows abnormal cells or an early cancer that no scan had picked up. Dr. Arena goes through that report with you at your follow-up visit.
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Drains
Drains, thin tubes that carry fluid away from your chest, stay in for the first days or weeks. Dr. Arena removes them in the office once the fluid slows.
What are the risks and side effects?
Two effects are permanent: loss of the ability to breastfeed and loss of feeling in your chest skin and nipples.
- Bleeding and infection: in the days after surgery.
- Seroma or hematoma: fluid or blood that collects under the skin and may need to be drained.
- Delayed wound healing: slower healing of the incisions or the skin over your chest.
- Loss of feeling: in a nerve-sparing mastectomy Dr. Arena leaves the nerves to your chest skin and nipples in place, which keeps some feeling for some women but not all.
- Post-mastectomy pain syndrome: burning or aching in your chest wall that continues after the wound has healed.
- Anxiety or depression about your body: some women find the change in their body hard to live with.
In studies, most women who had the operation were satisfied with the decision and less anxious about cancer afterward. [5]
How to choose the best surgeon for preventive mastectomy in Los Angeles?
- Double board certification: Dr. Arena is double board-certified in general surgery and complex general surgical oncology.
- Fellow of the American College of Surgeons (FACS): the College grants Fellowship after reviewing a surgeon's training, surgical case log and ethical conduct. [6]
- In-office tests: breast ultrasound and genetic test samples, without a separate imaging or lab appointment.
- Screening and surgery with one surgeon: if you start with screening and later choose surgery, Dr. Arena does both.
Dr. Elizabeth Arena brings advanced breast surgical technique to each preventive mastectomy, removing as much breast tissue as she safely can from behind the skin she leaves. After surgery you have a much lower chance of breast cancer and, if you have chosen reconstruction, breasts reconstructed around your own skin and where it was safe to keep them, your own nipples.
Frequently asked questions
What age should you have a preventive mastectomy?
There is no set age. Dr. Arena looks at which gene mutation you carry, the ages at which women in your family were diagnosed and whether you plan to have children and breastfeed. Many women have screening until they have finished having children and breastfeeding, then have surgery.
Can you still get breast cancer after a preventive mastectomy?
Yes, but rarely. [3] If you notice a lump or other change in your chest, Dr. Arena examines it and orders imaging when it is needed.
Are lymph nodes removed in a preventive mastectomy?
Usually not, because there is no known cancer to check for spread. If the pathologist finds an unexpected invasive cancer in the removed tissue, Dr. Arena talks with you about whether you need lymph node surgery afterward.
Does insurance cover a preventive mastectomy?
Many plans cover a preventive mastectomy and reconstruction when you meet the insurer's criteria for high risk. Those criteria differ between insurers. Dr. Arena's practice works with most major PPO plans with out-of-network benefits, plus cash pay and self-pay patients.
Sources
- American Cancer Society. Preventive Surgery to Reduce Breast Cancer Risk. https://www.cancer.org/cancer/types/breast-cancer/risk-and-prevention/preventive-surgery-to-reduce-breast-cancer-risk.html
- US Preventive Services Task Force. Breast Cancer: Medication Use to Reduce Risk. 2019. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-medications-for-risk-reduction
- National Cancer Institute. Surgery to Reduce the Risk of Breast Cancer. Updated December 2, 2025. https://www.cancer.gov/types/breast/risk-reducing-surgery-fact-sheet
- Cleveland Clinic. Prophylactic (Preventive) Mastectomy. Updated October 5, 2026. https://my.clevelandclinic.org/health/treatments/24025-prophylactic-mastectomy
- Breastcancer.org. Prophylactic (Preventative) Mastectomy. Reviewed by Austin D. Williams, MD, MSEd, FACS. Updated August 13, 2026. https://www.breastcancer.org/treatment/surgery/mastectomy/types/prophylactic
- American College of Surgeons. Surgeon Qualifications and Certifications. https://www.facs.org/for-patients/preparing-for-surgery/qualifications/
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