Learning that you carry a BRCA1 or BRCA2 mutation means learning about a risk — not facing a certainty. Several paths exist to reduce it, from enhanced surveillance to preventive surgery. The aim is to choose, calmly and without rushing, the option that fits your situation and your life plans.
Whether you are considering a preventive mastectomy, preventive removal of the ovaries, or simply weighing surveillance against surgery — Dr Zeitoun takes the time to explain the options and to build a strategy with you.
Genetic testing and counselling are carried out by a clinical geneticist; Dr Zeitoun then coordinates surgery, reconstruction and follow-up.
The BRCA1 and BRCA2 genes (from BReast CAncer) are "repair" genes: they correct errors in DNA. When they carry an inherited mutation, this repair works less well, and the lifetime risk of developing breast cancer or ovarian cancer rises markedly.
Carrying a BRCA mutation is not a disease, and it is not a certainty of cancer: it is a risk that can be monitored and reduced. Two broad strategies coexist: enhanced surveillance (notably breast MRI) and risk-reducing surgery — preventive mastectomy for the breast, removal of the ovaries and tubes for the ovary.
This article explains what a BRCA mutation means, how genetic counselling works, what preventive mastectomy and prophylactic salpingo-oophorectomy involve, their consequences, and how a personalised decision is built. It draws on the recommendations of the French National Cancer Institute and international guidelines (NCCN).
Dedicated consultation · clear explanation of options · personalised breast and ovary strategy
Genetic counselling and BRCA testing are carried out within a dedicated clinical genetics consultation.
A few key points before talking about prevention: what these genes do, how the mutation is passed on, and what "increased risk" actually means.
BRCA1 and BRCA2 are tumour-suppressor genes: they help repair damaged DNA. A harmful mutation reduces this repair capacity, which over the years favours the development of certain cancers.
This mutation is inherited in an autosomal dominant way: a carrier has a one-in-two chance of passing it to each child, daughter or son. Male carriers can also transmit the mutation and have their own associated risks.
The figures below are estimates of lifetime cumulative risk (to age 70-80), drawn from international studies and INCa recommendations. They are averages: your personal risk is clarified in genetic counselling, according to your gene, your age and your family history.
Key point: these risks are high but they are not 100%. Many carriers will never develop cancer. The aim of care is to lower that risk and to detect early, respecting your pace and your choices.
BRCA-related cancers sometimes have particular features: BRCA1 breast cancers are more often triple-negative and occur younger; BRCA ovarian cancers are usually high-grade serous and may respond to targeted therapy (PARP inhibitors) when they occur. These elements guide both surveillance and prevention choices.
It all begins with a clinical genetics consultation, carried out by a geneticist. Dr Zeitoun does not perform the test himself, but he organises this pathway with you and interprets its surgical implications.
The genetic counselling consultation maps your family tree: the ages and types of cancers among your relatives. This is what guides the indication for testing, the interpretation of the result and, where relevant, cascade testing of the family. You can also assess your hereditary risk and explore the assessment tools (Eisinger score, BOADICEA).
Diagnosis is made by a genetic analysis on a blood sample (or saliva), looking for a pathogenic variant of BRCA1 or BRCA2.
Some results are variants of unknown significance (VUS): neither reassuring nor alarming. They are reviewed regularly as new data emerge.
If a mutation is found, your relatives can be tested in turn, to benefit from tailored surveillance or prevention.
Options (surveillance, surgery) are discussed in a multidisciplinary meeting, then with you, with time to reflect. Nothing is imposed.
Important: being a carrier does not mean you must have surgery — but, depending on your profile, preventive surgery of the breast and/or ovary may be offered, or even recommended. For the breast, enhanced surveillance remains a legitimate alternative; for the ovary, with no reliable screening, preventive surgery has a particular place, at the right time. Learn more: prophylactic mastectomy · hereditary risk.
Bilateral prophylactic mastectomy is the most effective measure to reduce breast cancer risk in BRCA carriers. It is a considered decision, never urgent, prepared as a team.
When anatomy allows, a skin-sparing mastectomy with, if possible, nipple preservation (nipple-sparing) is preferred. Reconstruction is usually immediate, performed in the same operation.
The reduction in breast cancer risk is around 90 to 95%. A residual risk remains, as some breast tissue may persist; simple clinical surveillance is maintained afterwards. In the case of significant breast ptosis, a reduction or lift of both breasts may be performed at the same time to limit reconstruction complications.
Often raised from 25-30 years (BRCA1) or a little later (BRCA2), depending on the age of family cancers, anxiety, surveillance difficulty and any wish to breastfeed.
Mastectomy preserving the skin and nipple when feasible, for a good aesthetic result and easier reconstruction.
Reconstruction by implant is the most common. Flap techniques (latissimus dorsi, DIEP, gracilis) and fat grafting are also possible.
The removed tissue is examined under the microscope (histopathology) to look for any lesion not visible on imaging.
Dr Zeitoun is a reconstructive surgeon and performs the preventive mastectomy, offering the full range of reconstruction techniques: implant, latissimus dorsi flap, fat grafting, DIEP… Reconstruction is most often immediate. He does not personally perform the microsurgery step of free flaps, carried out with a microsurgery colleague. Further reading: all reconstruction techniques · mastectomy · prophylactic mastectomy · understanding your pathology report.
As there is no reliable screening for ovarian cancer, bilateral prophylactic salpingo-oophorectomy (removal of both ovaries and both tubes) is the most effective prevention in BRCA carriers.
The procedure is performed by laparoscopy (minimally invasive surgery, a few small incisions): complete removal of both ovaries and both tubes, with peritoneal inspection and careful histopathology.
It strongly reduces the risk of ovarian and tubal cancer (around 80 to 95% depending on the study). It is usually offered once you no longer plan a pregnancy. Learn more: risk-reducing salpingo-oophorectomy in detail (age, procedure, menopause).
As ovarian risk appears earlier with BRCA1, surgery is generally recommended between 35 and 40 years.
As ovarian risk is later, surgery can often be deferred by a few years.
The schedule takes your pregnancy plans into account; fertility-preservation options can be discussed beforehand.
The age of ovarian cancers among your relatives may lead to bringing forward or adjusting the timing.
Good to know: the uterus is not usually removed in the context of BRCA prevention alone. Any procedure on the uterus is discussed case by case, according to personal and family context.
Removing the ovaries before the natural age of menopause causes an immediate surgical menopause. These consequences can be anticipated and managed — an essential part of the decision.
Hot flushes, sleep disturbance and vaginal dryness may appear, as in natural menopause but more abruptly.
Lower oestrogen levels may increase, in the long term, the risks of osteoporosis and cardiovascular disease, especially in younger women.
In younger women without a history of hormone-dependent breast cancer, HRT can often be offered until the natural age of menopause.
This hormonal aspect is followed with your gynaecologist or endocrinologist, in line with your personal history.
To discuss in consultation: the indication for hormone therapy depends on your age, your history and whether the uterus is preserved. Contraindications, notably a history of hormone-dependent breast cancer, are carefully assessed.
Whether you choose surveillance or surgery, a structured follow-up is maintained — tailored to what has been operated on and what has not.
Enhanced breast surveillance combines clinical examination, breast MRI and mammography/ultrasound, on a schedule set by the team. It does not reduce the risk but allows early detection.
After preventive mastectomy, follow-up is simpler: regular clinical examination and attention to the reconstructed area.
A key examination in breast surveillance for high-risk women, combined as needed with mammography and ultrasound.
Regular examination and monitoring of the reconstruction; self-examination remains useful despite preventive surgery.
If only one breast is removed, the other remains under continued enhanced surveillance.
Some BRCA mutations carry other risks (pancreas, prostate in men) warranting family-wide awareness.
A BRCA mutation affects the body, but also self-image, family and the future. Care brings several areas of expertise together around you.
The team's role is not to decide for you, but to give you clear information and the time you need. Learning of a mutation can cause anxiety, sometimes guilt towards the family: specialist psychological support is valuable.
Around you: clinical geneticist, breast surgeon, plastic surgeon, gynaecologist, oncologist, radiologist, psycho-oncologist and endocrinologist — each in their place, working together.
Dr Zeitoun's role: a surgical oncologist, gynaecological and breast surgeon, he performs the preventive breast surgery and pelvic surgery (salpingo-oophorectomy), carries out the reconstruction himself (implant, latissimus dorsi, fat grafting, DIEP…) and coordinates follow-up, working with the different specialists. He sees patients for a first opinion as well as a second opinion before any decision.
BRCA1 and BRCA2 are genes that help repair DNA. When they carry an inherited alteration passed down through generations, this repair works less well and the risk of breast and ovarian cancer rises. The mutation is inherited in an autosomal dominant way: a carrier parent has a one-in-two chance of passing it to each child.
No. The mutation increases the risk; it does not make cancer a certainty. Many carriers will never develop cancer. This is why management is personalised and never automatic.
No, never. Preventive surgery is an option, not an obligation. The alternative is enhanced breast surveillance. The decision is yours, after full information and time to reflect, within a multidisciplinary discussion.
There is no fixed age. It is often discussed from 25-30 years (BRCA1) and a little later for BRCA2, taking into account the age of family cancers, anxiety, surveillance difficulty and any wish to breastfeed. It is a considered decision, never urgent.
Bilateral prophylactic mastectomy reduces the risk of breast cancer by around 90 to 95%. A residual risk remains because a little breast tissue may persist; simple clinical surveillance is maintained.
Often yes. When anatomy allows, the skin envelope and nipple are preserved and reconstruction is performed in the same operation. The technique is decided with you: Dr Zeitoun, a reconstructive surgeon, performs the full range (implant, latissimus dorsi, fat grafting, DIEP). He does not personally perform the microsurgery step of free flaps, carried out with a microsurgeon.
It is the preventive removal of both ovaries and both tubes (bilateral salpingo-oophorectomy), performed by laparoscopy. It is the most effective measure to prevent ovarian and tubal cancer, usually offered once you no longer plan a pregnancy.
Timing depends on the gene and on pregnancy plans. It is generally recommended around 35-40 years for BRCA1, and can be deferred to around 40-45 years for BRCA2, ideally once you no longer plan a pregnancy. The schedule is decided together.
Yes, before the natural age it causes immediate surgical menopause. In younger women, hormone replacement therapy can often be offered until the usual age of menopause, unless contraindicated. This is followed with your gynaecologist or endocrinologist.
It may contribute by reducing hormonal exposure, but the exact size of this effect is currently debated in the scientific literature. Its main, well-established benefit remains the strong reduction in ovarian and tubal cancer risk.
Enhanced breast surveillance combines clinical examination, breast MRI and mammography/ultrasound on a set schedule. However, there is no reliable screening for ovarian cancer: for the ovary, preventive surgery is favoured at the right time.
You are entirely free to inform your relatives or not — it is your choice. If you wish, cascade testing allows relatives who want it to find out whether they are carriers and to access surveillance or prevention. The genetics team can help you with this, at your own pace.
Risk-reducing surgery in a BRCA carrier is recognised and covered by the French health system. Dr Zeitoun charges additional fees (secteur 2 non-OPTAM), explained in consultation and set out in a written estimate provided before surgery.
To go further on assessing your risk and on the preventive procedures of the breast and ovary.
Assess your hereditary risk in a few questions (Eisinger score) and understand when to seek genetic counselling.
Breast surgeryPreventive mastectomy in detail: techniques, nipple preservation, immediate reconstruction.
Gynaecological cancerWhen an ovarian lesion turns out to be malignant: diagnosis, cancer surgery and the MDT pathway.
After mastectomyAll techniques by Dr Zeitoun: implant, latissimus dorsi, fat grafting, DIEP — immediate or delayed.
Your resultsTriple-negative, grade, hormone receptors: how to read and understand your report.
Ovary surgeryPreventive removal of the ovaries and tubes in detail: age, laparoscopic procedure, menopause and follow-up.
Confirmed BRCA mutation, strong family history, or simply the need for a second opinion before choosing between surveillance and surgery: Dr Jérémie Zeitoun consults at his practice in the 8th arrondissement of Paris and operates at Clinique Hartmann in Neuilly-sur-Seine. Bring your genetic report and your examinations for a dedicated consultation.
Genetic testing and counselling are carried out by a clinical geneticist; hormonal follow-up is provided with your gynaecologist or endocrinologist.