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Risk Reducing Surgery FAQs

Risk Reducing Breast Surgery

What are the risk reducing breast surgery options?
Risk reducing surgery for breast cancer means surgery to remove breast tissue to lower the risk of breast cancer. This is usually offered as an option to some women at a high risk of breast cancer.

Further information on these procedures, can be found on the Pink Hope website on the risk management page.

The Breast Cancer Institute of NSW provides an information guide for patients facing an upcoming breast cancer operation.

At what age can I have risk reducing breast surgery?
There is no specific age that is recommended for women planning risk reducing surgery. The decision to have risk-reducing surgery, and when to have it, is a personal one. Many women consider this surgery in their 30s and 40s, but there are many factors to take into account.

How do I decide whether to have risk reducing breast surgery?
Research has shown us that consulting with a variety of specialists and a psychologist, ideally before and after the surgery helped women feel as informed as possible, prepared for the surgery and helped their adjustment after surgery.

Firstly it may be helpful to understand your risk of breast cancer as best you can. Thinking about how risk changes over time can be useful. For example, thinking about “What is my risk between age 30 and 40? Between 40 and 50? etc “ can help you see if the decision is one to think about now or in a few years’ time. Other important questions are how surgery will fit in with your life and life choices. For example, how will it fit around breastfeeding, caring for your children, study and work? A genetic counsellor can give you information on your risk, your surgeon can discuss the types of surgery that may be available and a psychologist is another healthcare professional you may wish to consult. They can help you plan for and adjust to any decision you make, and guide you through the changes you will face along your journey.

People make decisions in different ways. It can be helpful to think about difficult decisions you have made in the past and what was helpful and what was not. This may include thinking about how you weigh up pros and cons, who and what the influences on your choices are, how you are feeling about cancer risk, your general well-being, your body image, sexual health and what worries and hopes you have for the future. In addition to health professional support, learning about real life experiences from women who have been through the surgery provides good insight for women planning surgery.

Being informed and realistic about what each option means helps many women have confidence in the decision they ultimately make.

NSW Genetics Education has provided a booklet with information for women considering prophylactic surgery. The PDF can be downloaded here

What are the costs involved?
Risk reducing breast surgery (mastectomy and reconstruction) is offered in the public health care system. It is usually offered in metropolitan centres in Australia. There are no out-of-pocket costs for publically funded surgery.

The same breast surgery can be undertaken in the private system but there are often significant out-of-pocket costs. After visiting the appropriate doctors, you will be able to obtain an estimate of costs, and can tell you what any Private Health Insurance will and will not cover, which you can use to make your decision.

Where do I start?
The process usually begins following having an assessment of your risk by your local doctor and a Family Cancer Clinic. If you are at high risk, your doctor or the Family Cancer Clinic can then refer you to a breast surgeon.

Who helps me arrange risk reducing breast surgery?
Regardless of where you choose to have the surgery, i.e. in the public or private system, a breast surgeon would oversee the process for you. The process can involve multiple appointments with both the breast surgeon, a plastic surgeon, psychologist (if available) and any other relevant health professionals.

In the public setting after you have had the planning appointments you will be placed on a waiting list. The length of time a women waits on the list can vary and your surgeon will advise you on this.

In the private setting, there can still be a wait for the surgery, and this again would be best answered by the breast surgeon involved.

Risk Reducing Ovarian Surgery

What are the risk reducing ovarian surgery options?
The removal of both ovaries and fallopian tubes (bilateral salpingo-oophorectomy) generally at about age 40 is the recommended way of reducing ovarian cancer risk for women with a high lifetime risk. This is most often a laparoscopic (key-hole) procedure. More information can be found about this option on the risk management page on the Pink Hope website.

How do I decide whether to have risk reducing ovarian surgery?
Research has shown us that consulting with a variety of specialists and a psychologist, ideally before and after the surgery helped women feel as informed as possible, prepared for the surgery and helped their adjustment after surgery.

Firstly it may be helpful to understand your risk of ovarian cancer as best you can. Thinking about how risk changes over time can be useful. For example, thinking about “What is my risk between age 30 and 40? Between 40 and 50? etc” can help you see if the decision is one to think about now or in a few years’ time. Other important questions are how surgery will fit in with your life and life choices. For example, how will it fit around family planning, caring for your children, study and work? A genetic counsellor can give you information on your risk, your surgeon can discuss the types of surgery that may be available and a psychologist is another healthcare professional you may wish to consult. They can help you plan for and adjust to any decision you make, and guide you through the changes you will face along your journey.

People make decisions in different ways. It can be helpful to think about difficult decisions you have made in the past and what was helpful and what was not. This may include thinking about how you weigh up pros and cons, who and what the influences on your choices are, how you are feeling about cancer risk, your general well-being, your body image, sexual health and what worries and hopes you have for the future. In addition to health professional support, learning about real life experiences from women who have been through the surgery provides good insight for women planning surgery.

Being informed and realistic about what each option means helps many women have confidence in the decision they ultimately make.

Cancer Australia has provided a booklet with information for women considering prophylactic surgery. The PDF can be downloaded here.

Can I go on Hormone Replacement Therapy?
Maybe. This depends on many factors such as your age, general health and previous cancer history. For some women there are benefits to using HRT, while others are advised not to have HRT. Taking HRT for a few years in a woman in her 40s (who has had her ovaries removed) who has not had cancer does not seem to increase cancer risk, but research is still studying this carefully.

If you have not already gone through menopause, then surgery to remove your ovaries will cause your oestrogen levels to drop quickly, putting you into menopause. This does not mean you will definitely have symptoms. It is not possible to predict who will have any. The surgery will not make you look less feminine or less youthful. Possible symptoms include hot flushes, particularly at night, vaginal dryness and changes in energy, sexual drive and mood. Hormone replacement therapy and/or other medications can help with some symptoms if they do happen. We recommend that you speak to your doctor and possibly a specialist menopause clinic before having risk-reducing ovarian surgery. It is important to know that there are many options and professionals to help you decide on surgery and manage its impact, as your general health, including sexual function and body image, is as important as reducing cancer risk.

See the Surgical Menopause Fact Sheet produced by the Australian Menopause Society for more information.

What are the costs involved?
Risk reducing gynaecological surgery (removal of the ovaries and fallopian tubes) is offered in the public health care system. It is usually offered in metropolitan centres in Australia. There are no out-of-pocket costs for publically funded surgery.

The same surgery can be undertaken in the private system but there can be out-of-pocket costs. After visiting the appropriate doctors, you will be able to obtain an estimate of costs, and can tell you what any Private Health Insurance will and will not cover, which you can use to make your decision.

Where do I start?
The process usually begins following having an assessment of your risk by your local doctor and a Family Cancer Clinic. If you are at high risk, your doctor or the Family Cancer Clinic can then refer you to a specialist gynaecological surgeon.

Who helps me arrange risk reducing ovarian surgery?
Regardless of where you choose to have the surgery, i.e. in the public or private system, a gynaecological surgeon would oversee the process for you. The process can involve a pre surgical appointment, discussion with a psychologist (if appropriate and available) and any other relevant health professionals such as a menopause specialist.

In the public setting after you have had the planning appointments you will be placed on a waiting list. The length of time a women waits on the list can vary and is best answered by the gynaecologist coordinating the surgery.

In the private setting, there can still be a wait for the surgery, and this again would be best answered by the gynaecologist involved.

Support and Resources

What support and resources are available?
There are several healthcare professionals who may provide care and support during your journey. These include GPs, specialist nurses, specialist doctors, psychologists and clinical genetic specialists. These professionals can help explain all of the available information regarding risk prevention, surveillance, screening, treatment, and post-treatment options.

Other useful resources:
Cancer Australia
Centre for Genetics Education

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