La reconstruction mammaire par implant est la technique la plus courante après mastectomie. Elle restaure immédiatement le volume du sein, en un ou deux temps opératoires selon la qualité de la peau.
A surgical consultation after a BRCA diagnosis is first and foremost about hearing every option, surveillance included. Dr Zeitoun will go through your genetics report and your imaging, and you leave with a written plan — no decision required on the day.
Genetic counselling and the surveillance protocol are managed by the cancer genetics team; any surgical proposal is discussed at a multidisciplinary team meeting.
There is a moment nobody talks about: the one where you walk out of the genetics clinic holding a sheet of paper, with a single sentence going round in your head — "you carry a BRCA mutation." The available articles explain very well what a preventive mastectomy or removal of the ovaries involves. Almost none explain what happens between the result and the decision.
Yet that is where everything is decided. The days that follow are made of late-night searching, contradictory figures and a sense of urgency. So let us say it straight away: you will be offered preventive surgery, to the breast and to the ovaries, because it substantially reduces the risk. And it will not be imposed on you. Those two sentences do not contradict each other.
This article does not go into operative technique — that is covered in BRCA preventive surgery, prophylactic mastectomy, risk-reducing salpingo-oophorectomy and breast reconstruction. It answers a different question: where to begin.
After a BRCA diagnosis, a surgical consultation is first and foremost about hearing every option, surveillance included. Dr Zeitoun will go through your genetics report and your imaging, and you leave with a written plan.
Nobody ends up in a cancer genetics clinic by accident. Understanding which of these four doors brought you there directly shapes how your result should be read — and what you will be offered next.
Before any test, the cancer genetics team maps out your family tree: who had which cancer, at what age, and on which side. It is that pattern, far more than the raw number of cases, that determines whether genetic analysis is offered.
Taking the time to prepare it beforehand — calling an aunt, a cousin — often transforms the quality of the assessment. The risk assessment tools are built directly on it.
A breast cancer or an ovarian cancer has been diagnosed, and certain features — age at diagnosis, tumour type, involvement of both breasts — point towards a possible predisposition. Testing is then carried out on you, because it is in someone affected that the causative anomaly is most likely to be found. The surgical strategy — lumpectomy or mastectomy, sentinel lymph node — is discussed in parallel.
A parent, a sister or a cousin has been tested and carries an identified mutation. You are then offered targeted testing: only that specific variation is looked for. It is simpler, faster, and the answer is binary — you either inherited it or you did not.
Several breast or ovarian cancers in the family, early diagnoses, sometimes a breast cancer in a man. You come in order to know where you stand, without being ill yourself. It is often a formal risk score that triggered the referral — see the risk assessment tools. Other situations amount to high risk without an identified mutation.
A very concrete question, and often the real reason for testing: should the other breast be treated, and how? In a carrier, the risk of contralateral breast cancer is markedly higher, which changes the discussion around mastectomy of the healthy breast and the lumpectomy versus mastectomy trade-off. Post-mastectomy pain is among the topics to raise.
Why this matters: in situations 1 and 4, the result guides treatment already under way and timing carries more weight. In situations 2 and 3, you are in good health and you have all the time you need. Ask which logic your own file falls under — it is the first thing to establish.
The word "positive" covers very different situations, and one of the most misunderstood is the one where nothing is found. Check on your report which situation applies to you.
The test has identified, in every cell of your body, a variation in a gene involved in DNA repair. That variation increases the probability of developing breast or ovarian cancer over a lifetime. It says neither that the disease will occur, nor when.
A substantial number of carriers never develop cancer. And the excess risk plays out over several decades — which is the underlying reason why nothing needs deciding in the week after the result.
This is the "positive" result in the strict sense: the variation is recognised as causing an increased risk. You will be offered enhanced surveillance and the risk-reducing options — preventive mastectomy and preventive removal of the ovaries and tubes. Your relatives can be offered targeted testing. Any surgical specimen undergoes systematic pathological analysis.
A variant of uncertain significance: a variation exists, but we do not currently know whether it has any effect. It is not a mutation. It justifies no preventive surgery and does not change your management, which remains based on your personal and family history. Its classification may change: stay in touch with the team.
This is the result people wrongly read as an all-clear. Finding nothing is not the same as being at no risk. As of 2026, not all predisposition genes are known, and current techniques do not detect every anomaly. The gene behind your family history may well exist — we simply cannot read it yet.
If you were referred for genetic counselling, it was because your personal or family history justified it — and that history does not change with the result. Many women with no identified mutation remain high-risk patients, under enhanced surveillance whose protocol the cancer genetics team sets precisely. Do not let the follow-up lapse.
Worth remembering: always ask for your written report, with the name of the gene and the exact designation of the variant. That document underpins everything else — targeted testing for your relatives, discussion at the multidisciplinary meeting, the surgical consultation. Without it, no clinician can reason about your actual situation.
A BRCA predisposition involves two organs, several specialties and decades of follow-up. That is what makes the pathway disorienting: nobody handed you an organisation chart. Here is one.
They issued the result and remain your point of entry. They clarify the risk attached to your specific variant, provide the written report, and above all set the surveillance protocol — which examinations, how often, from what age. A second appointment some weeks after the disclosure is often useful: nobody takes it all in first time.
Ideally trained in both breast and gynaecological surgery, since both organs are involved and their timetables interlock. At this stage their role is not to operate: it is to set out every option and let you choose. On what actually matters when choosing, see how to choose your breast surgeon.
They provide local continuity: imaging requests, contraception, working up a possible breast lump or a benign breast condition, long-term support. They are the ones you will see most often over the years, and they should receive every report.
Your file is presented at a multidisciplinary team meeting, which formulates a proposal. A proposal is not an instruction: the decision is yours, and "not now" is one of the available answers.
Many women put off the surgical consultation, convinced it only makes sense once the decision to operate has been made. The opposite is true: seeing a surgeon early is what allows you to decide with full information, using figures that match your situation rather than an average read online at two in the morning.
That consultation sets no automatic process in motion. Many patients leave with a surveillance plan and nothing else — sometimes for good.
On second opinions: Dr Zeitoun regularly sees patients for a second opinion after a BRCA diagnosis — often where preventive surgery has already been raised elsewhere and they want to go through the file calmly, without pressure. Doing so interrupts no care already under way.
Emotion wipes out the essentials. These eight questions, asked in this order, cover everything that needs clarifying. Print them and bring them — no surgeon will mind; quite the opposite.
Emotion erases half of what you meant to ask. Arriving with a written list is the single most effective way of not forgetting anything — and of leaving with real answers.
No surgeon will take it badly. If anything it signals a patient who intends to decide with full information rather than accept a proposal passively.
The figures in circulation are population averages. Your actual risk depends on the gene involved, your current age, your family history, sometimes personal factors. Ask for the general percentage to be translated into an estimate that fits you.
This is the question that brings the most relief. It separates what must be organised quickly — surveillance — from what belongs to open-ended reflection: surgery. Ask for both lists to be named explicitly.
Surveillance alone is a medically sound option, not a failure of nerve. Ask for each pathway to be presented with its expected benefit and its limitations — an account mentioning only surgery would be incomplete.
Ask for the specifics: which examinations, in which months, requested by whom, and what would happen if an image were graded as equivocal (BI-RADS). Surveillance rests largely on annual breast MRI, alongside mammography, breast ultrasound and a six-monthly clinical examination. The exact protocol comes from the cancer genetics team.
Breast and ovaries do not follow the same timetable. The ovarian side is tighter, because there is no reliable screening for ovarian cancer; the breast, by contrast, benefits from effective surveillance. Ask for the reasoning to be spelled out, not just the conclusion.
A legitimate question, to be asked plainly. A preventive mastectomy can be combined with reconstruction at the same operation, delayed by months, or with no reconstruction at all — a choice, never an obligation. Ask to see results and to understand what implant, DIEP flap, latissimus dorsi or gracilis reconstruction really involves — not forgetting lipofilling, areola reconstruction and the flat closure option.
Central before 40, and often forgotten in the emotion. A BRCA mutation does not impair fertility in itself, but it shapes the timetable — removal of the ovaries causes permanent infertility and is only considered once you have completed your family. Fertility preservation and contraception are handled by specialist teams to whom you will be referred.
The weak point of BRCA pathways is not expertise: it is coordination. Ask who specifically requests the imaging, who receives the reports, and which number to call with a question in between. Leave with a name, not a specialty. Use the opportunity to clarify timelines, cover and fees — a written estimate is provided before any procedure.
Dr Zeitoun is a surgical oncologist in breast and gynaecological surgery: the breast and ovarian sides are discussed together, on a single timetable — with a second opinion available if surgery has already been proposed elsewhere. Consulting rooms in central Paris, surgery at Clinique Hartmann in Neuilly-sur-Seine.
Hormonal management and local follow-up are coordinated with your gynaecologist, family doctor or midwife.
Let us be clear on this, because it causes a great deal of anxiety. In a woman carrying a confirmed mutation, risk-reducing surgery — breast, ovarian, or both — will be offered to you, because it substantially reduces the risk of cancer. It never becomes an obligation.
The excess risk linked to a BRCA mutation plays out over several decades. Nothing in your file requires a decision this week — or this quarter. What matters is that surveillance gets under way.
Some women, after long surveillance, eventually opt for surgery; others postpone and never regret it. Both paths are legitimate, and both are revisited at each annual consultation.
Removing the breast tissue on both sides very substantially reduces the risk of breast cancer. It can be combined with immediate reconstruction, with reconstruction delayed by months or years, or with no reconstruction if that is your choice. Techniques, scars and recovery are set out under prophylactic mastectomy and mastectomy.
Removing both ovaries and both tubes by laparoscopy is the most effective measure against ovarian cancer, given the absence of reliable screening. It brings on a surgical menopause that needs planning for, and is only considered once you have completed your family. See risk-reducing salpingo-oophorectomy.
Choosing not to be operated on is a sound decision that nobody should hold against you. In that case the cancer genetics team gives you a precise protocol: which examinations, how often, from what age. That protocol is not a formality — it is what makes the option safe. It must be followed to the letter.
Nothing is locked in. Some women, after long surveillance, decide to have surgery; others postpone and do not regret it. The choice is revisited at every annual consultation, in light of your age, your plans and what you feel able to carry.
They come up in almost every consultation. Knowing about them in advance is often enough to shake them off.
A lifetime risk is not a probability for the coming year, and it falls with every year already lived without cancer. Ask for the figure to be personalised.
Forums and social media mix very different situations — different genes, different ages, countries with different practice. Invaluable for support, misleading for decisions.
Postponing the surgical decision is legitimate; postponing the MRI is not. Surveillance is the one thing that must never slip, however long you take to reflect.
Worth remembering: you do not have to arrive at a consultation with a decision. You are entitled to say "I don't know", "not now", or "I want to talk to someone first". Psychological support or a patient association can help — that is not an admission of fragility, it is part of the pathway.
A well-prepared consultation is worth two improvised ones. The aim is simple: that the surgeon reasons about your actual file, not about what you can remember of it. General guidance is on preparing for your first consultation.
The genetics report, recent imaging, the family tree and your questions: gathered in a single folder, they let the surgeon reason about your actual file from the first minute.
Without them the consultation stays theoretical and will have to be repeated. It is the difference between leaving with a written plan and leaving with an impression.
State from the outset whether you have come to gather information or because you already have an instinct. It completely changes how the consultation should be run.
Repeat what you have understood and have it corrected. It is the most reliable way of catching a misunderstanding — they are common and rarely deliberate.
A report, or at minimum a few lines summarising the options and the protocol. That is the document you will reread once the dust settles, and show to your other doctors. If surgery is then scheduled, see preparing for surgery and postoperative recovery.
If you bring only one thing: the genetics report. Without it the consultation stays theoretical — and will have to be repeated.
This is often the heaviest part of the disclosure: the result does not concern you alone. It opens up screening for your relatives that they would not otherwise have had. But the timing, the manner and the recipients: you choose all of them.
You draw up with the cancer genetics team a list of relatives who may be concerned. From there, two routes are open: tell them yourself, using the information documents you are given, or ask the doctor to take it on.
In that second case, the doctor sends a letter that mentions neither your identity nor the diagnosis: the person is simply invited to book an appointment at a genetics clinic. Each of them is then free to follow it up or not.
Parents, siblings, adult children: each has a one in two chance of having inherited the same variation. Their test is targeted — only the variation known in your family is looked for — so it is simpler and quicker than yours was.
A BRCA mutation passes down equally through the father or the mother, and it affects men too — an increased risk of male breast cancer and of prostate cancer, particularly with BRCA2. An untested brother or father can pass the variation on to his own children.
Testing is not offered before adulthood: no preventive measure applies in childhood, and the information would be carried without benefit. The question arises from the age of 18, and in practice often between 20 and 25, when surveillance would start to be useful.
Nothing obliges you to tell everyone in the week of the result. Many women start with one or two people close to them, then widen the circle once they have digested it themselves. Others wait months. Your pace is yours, and the cancer genetics team supports you without pushing.
Worth remembering: family screening is the collective benefit of your test. It lets relatives enter appropriate surveillance before any disease — and lets others learn that they are not carriers, and step out of the family's anxiety altogether. The exact arrangements are explained by your cancer genetics team.
Preventive breast surgery, preventive removal of the ovaries, or simply understanding your options: Dr Zeitoun consults in central Paris and operates at Clinique Hartmann in Neuilly-sur-Seine. Second-opinion consultations welcome.
No. A positive result means you carry, in every cell of your body, a variation in a gene that increases the risk of developing breast cancer or ovarian cancer over a lifetime. It is not a diagnosis of disease, and a substantial number of carriers never develop cancer. The result opens a period of surveillance and reflection, not treatment.
Four situations lead there: a newly diagnosed cancer of the breast or ovary, particularly before 50 or with specific tumour features; a recent cancer in the family, with or without a mutation already identified in a relative; a heavily affected family history, where several cases prompt an assessment of your own risk; and, in a woman already treated for breast cancer, the need to decide what to do about the other breast.
Not necessarily. The absence of an identified mutation does not mean the absence of risk. As of 2026, not all predisposition genes are known, and current techniques do not detect every anomaly. If you were referred for genetic counselling it was because your personal or family history justified it — and that history does not change with the result. You may therefore remain a high-risk patient, under enhanced surveillance whose protocol the cancer genetics team sets precisely. See hereditary breast and ovarian cancer risk and the risk assessment tools.
The cancer genetics team that issued the result remains your point of entry: they set the surveillance protocol. They will then refer you to a surgical oncologist trained in both breast and gynaecological surgery, since both organs are involved — see how to choose your breast surgeon. Your gynaecologist or family doctor remains the local coordinator.
Because a surgical consultation commits you to nothing. It exists so that you know every option precisely — surveillance alone included — with the benefits and limitations of each. Many women consult, inform themselves, and choose surveillance. Making an informed decision means having heard all the options — see BRCA preventive surgery and Dr Zeitoun's background.
Eight questions frame the consultation usefully: what your variant changes specifically for you; what is urgent and what can wait; every option, surveillance included; what a year of surveillance actually involves; the order in which surgery would be considered; what the result looks like after a preventive mastectomy with or without reconstruction; the implications for fertility; and finally who coordinates the follow-up, with timelines and a written estimate — the appointments page sets out the practical arrangements.
No. Risk-reducing surgery, to the breast and to the ovaries, is routinely offered to a woman carrying a confirmed mutation because it substantially reduces the risk of cancer. But it is never imposed. The choice is entirely yours, it can be postponed, and it can be revisited. If you opt for surveillance, the cancer genetics team gives you a precise follow-up protocol, built around annual breast MRI, mammography and ultrasound — all the more decisive with dense breasts. If an image needs investigating, see breast biopsy and how long results take.
No. Breast reconstruction is an option, not an obligation. It can be carried out at the same time as the mastectomy, delayed by months or years, or not carried out at all. Some women deliberately choose to go flat. The various techniques — implant, DIEP flap, latissimus dorsi — as well as the deliberate choice of flat closure are explained at consultation, along with the immediate or delayed timing.
There is no single order. The reasoning takes account of age, the gene involved, family history and plans for children. The ovarian side follows a tighter timetable because there is no reliable screening for ovarian cancer, whereas the breast benefits from effective MRI surveillance. See risk-reducing salpingo-oophorectomy, prophylactic mastectomy and breast reconstruction.
That is your decision, and nobody will make it for you. In practice you draw up with the cancer genetics team a list of relatives who may be concerned, then you choose: tell them yourself, using the information documents you are given, or ask the doctor to do it. In that second case the doctor sends a letter that mentions neither your identity nor the diagnosis, simply inviting the person to book a genetics appointment. Your relatives then remain free to have testing or not — to understand what is being assessed, see hereditary risk and, for the men in the family, male breast cancer.
No. BRCA testing is not offered to minors, because no preventive measure applies before adulthood. It is usually considered from the age of 18, and in practice often discussed between 20 and 25, when surveillance would start to be useful. Each child, daughter or son, has a one in two chance of having inherited the mutation. When the time comes, the assessment uses the same risk tools and a targeted test.
It is a variation in the gene where we do not currently know whether it increases risk. A VUS is not a pathogenic mutation: it justifies no preventive surgery and does not change your management, which remains based on your personal and family history. Its classification may change over time, which is why it is worth staying in contact with the cancer genetics team and continuing the follow-up defined from your risk assessment and your family history.
Yes. A BRCA mutation does not impair fertility in itself and does not rule out pregnancy. It does shape the timing of decisions, since preventive removal of the ovaries causes permanent infertility and is only considered once you have completed your family. Fertility preservation is handled by specialist teams to whom you will be referred. See also surgery of the ovaries and tubes, ovarian cancer, borderline tumours and gynaecological cancers as a whole. Associated hysterectomy is considered case by case.
Yes. Dr Zeitoun regularly sees patients for a second opinion after a BRCA diagnosis, particularly where preventive surgery has already been raised elsewhere and the patient wants to go through her file calmly. The consultation interrupts no care already under way. Please bring your genetics report and recent imaging. On what actually matters, see how to choose your breast surgeon and Dr Zeitoun's background.
Genetic counselling, testing and surveillance are covered by the French health service, as is risk-reducing surgery in a woman carrying a confirmed mutation, which is a medically justified procedure. Dr Zeitoun charges above the standard fee schedule (secteur 2 non-OPTAM); these fees are explained at consultation and set out in a written estimate provided before any procedure. The practical arrangements are detailed on the appointments page.
Once the moment of disclosure has passed, these pages set out each of the options mentioned here.
The full risk-reduction strategy for BRCA1 and BRCA2 carriers: breast, ovaries, surveillance and surgery.
BreastPreventive removal of breast tissue: indications, techniques, scars, and immediate or delayed reconstruction.
OvariesRecommended age, laparoscopic procedure, surgical menopause and follow-up after removal of the ovaries and tubes.
Choosing wellThe criteria that genuinely matter when choosing a breast surgeon, and the questions to ask before committing.
Hereditary riskUnderstanding hereditary predisposition, the role of the BRCA genes, and the criteria that lead to genetic testing.
Men affected tooWhy the men in your family are concerned by a BRCA2 mutation, and what follow-up is offered to them.
You have just received a positive result, or preventive surgery has already been proposed elsewhere and you would like a second opinion: Dr Jérémie Zeitoun consults in central Paris and operates at Clinique Hartmann in Neuilly-sur-Seine. Bring your genetics report and recent imaging — the consultation commits you to no procedure.
Genetic counselling, the surveillance protocol and the arrangements for informing your family are managed by your cancer genetics team.