Between the Scalpel and the Scar: A Breast Surgeon’s Journey as a BRCA1 Carrier

BRCA1 and BRCA2 mutations significantly increase lifetime risk of breast and ovarian cancers. Despite growing awareness, few Indian women opt for preventive risk-reducing surgery due to cultural stigma, lack of genetic counselling, and limited access to multidisciplinary care. This article presents a dual perspective—of a breast oncoplastic surgeon and BRCA1 mutation carrier—navigating the complex decision-making and lived experience of bilateral prophylactic nipple-sparing mastectomy with reconstruction. This is a personal reflective account combining professional and patient experiences. It describes the process of decision-making, emotional and physical challenges, and the importance of multidisciplinary support during risk-reducing surgery. The experience revealed several critical insights: (1) awareness of genetic risk, while empowering, can also provoke emotional distress marked by fear, guilt, and uncertainty; (2) cultural and societal perceptions surrounding mastectomy and body image remain major barriers to preventive care; (3) navigating the dual roles of surgeon and patient highlighted the essential role of empathy, patient education, and psychological support in decision-making; (4) multidisciplinary involvement—genetic counselling, psychological assessment, and reconstructive planning—enhances patient preparedness and satisfaction, and (5) the lack of awareness amongst Indian women about genetic disease and management. Preventive mastectomy in BRCA carriers should address not only the medical aspects but also the emotional and cultural ones. Greater awareness, access to counselling, and open conversations about genetic risk are essential in India. Prevention is not only a medical decision—it is also an act of courage, self-care, and taking control of one’s future.