Prophylactic breast removal preserves the skin over the breast and usually also the areola and the nipple. Reconstruction can be done during the same procedure either with an implant or using a flap.
Preventative (prophylactic) mastectomy is surgical removal of one or both breasts in women who do not have breast cancer. You may consider having a preventative mastectomy if you have a strong family history of breast cancer and/ or if genetic testing suggests a substantial likelihood that you may be diagnosed with breast cancer in future. Preventative mastectomy is a big decision. It involves much consideration, consultation with healthcare professionals and genetic counselling. Most women who have a preventative (prophylactic) mastectomy have both breasts removed simultaneously (bilateral mastectomy).
Prophylactic mastectomy usually means the overlying skin envelope, and in many cases also the nipple with the areola can be sparred. Radiation therapy is not indicated, and immediate breast reconstruction with an implant or flap is the best option. If the nipple and areola are preserved, it is usually done as a single stage procedure. Having both breasts reconstructed at once means they are more likely to be symmetrical.