Requests for a prophylactic mastectomy, common in the USA, are increasing in France.

It can be totally irrational, as the result of a panic reaction from the patient when the cancer is diagnosed (remove me everything on both sides…). In that case, one must not grant that wish as all studies have shown that there is no medical upside (no prognosis gain), apart from particular genetical risk cases.

It can be discussed, ideally during an RCP, in very particular situations after the diagnosis of cancer on one breast and a case for « high risk» breasts:

– with acknowledged opposite breast histological abnormalities (atypical hyperplasia, in situ lesions…)

-confronted to a very difficult radiological monitoring (fibrocystic breasts, microcalcifications…), that may cause a delayed diagnosis.

It can be totally justified after discovering a genetic defect. In that case, patients have to choose between a strict radiology monitoring and a preventive prophylactic mastectomy. 4 situations, that seem close but where the stakes are very different, can occur: