Medical Oncologist
CION Cancer Clinics
Having children before or after risk-reducing surgery | CION Cancer Clinics
If you carry a gene fault such as BRCA1, BRCA2 or a Lynch gene, preventive surgery may be offered to lower your cancer risk. Some of these operations end the chance of a natural pregnancy, and some do not. The timing is a balance between the years you want for a family and the risk that builds while you wait. This page explains how couples usually weigh it. At CION Cancer Clinics, our team helps carriers and their families plan checks, next steps and support after a genetic result.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed September 2026, next review due September 2027
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On this page
- Should I have children before risk-reducing surgery?
- Which preventive operations affect having children?
- How is the timing usually planned?
- The terms that come up, in plain language
- Children first or ovary surgery first: the trade-offs
- What this page cannot tell you
- Four things women tell us, and what is actually true
- Common questions about pregnancy and preventive surgery
The short answer
Should I have children before risk-reducing surgery?
For most carriers who want children, yes. Removing the ovaries and tubes ends natural pregnancy, so guidelines usually suggest it once a family is complete, at an age that depends on the gene. Removing the breasts does not stop you becoming pregnant. It only means you cannot breastfeed from the breasts that were removed.
Why the timing matters so much
Ovarian cancer is hard to find early, and no screening test reliably catches it in time. That is why surgery, not scans, is the main protection for women with a BRCA fault. Waiting longer for a family means living longer without that protection. With BRCA1 the risk tends to rise earlier than with BRCA2, which is one reason the advice differs by gene.
Why it is not only a medical decision
In many Indian families, marriage and children are expected on a timetable that parents and in-laws feel strongly about. A counsellor can help you work out your own timeline first, and then how to explain it at home, including to a future spouse.
Risk-reducing surgery is one option among several, set out on our page on ways to reduce hereditary cancer risk. It is never an emergency.Which operation affects what
Which preventive operations affect having children?
Each operation affects fertility differently. This is the broad picture for planning a family, not a guide to the surgery itself.
Removing the ovaries and tubes
Ends natural pregnancy and brings on menopause straight away. The womb stays, so a pregnancy is still possible later using frozen embryos or donor eggs. This is the operation where timing matters most.
Often offered to
- Women with a BRCA1 or BRCA2 fault
- Some women with a Lynch syndrome fault
- Carriers of a few other ovarian cancer genes
Removing the breasts
Does not affect fertility or the ability to carry a pregnancy. Breastfeeding from the removed breasts is no longer possible. Some women time this after their last baby, with closer breast screening until then.
Removing the womb
Sometimes offered to women with Lynch syndrome, because the fault raises the risk of womb cancer. After this, carrying a pregnancy is no longer possible, so it is usually planned once a family is complete.
Removing the tubes first
Some studies are testing removal of the tubes early and the ovaries later, to delay menopause. This is still being studied and is not yet standard care. Ask whether a trial could suit you.
Not sure whether this applies to you?
Ask an oncologistStep by step
How is the timing usually planned?
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Have the gene result explained
A genetic counsellor explains what your fault means, which operations are relevant and at what stage of life each is usually offered for your gene.
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Map out your family plans
Think about when you hope to marry, how many children you want and how soon. There is no right answer, and plans often change along the way.
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Agree extra screening in the meantime
While you wait, breast screening may start early and be more frequent. Your team will explain what, if anything, is useful for the ovaries and where its limits are.
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Consider freezing eggs or embryos
If surgery may need to come before your family is complete, freezing eggs or embryos first keeps a later pregnancy possible. Embryos can also be tested for the family fault.
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Plan surgery after your last pregnancy
Many women have surgery once breastfeeding ends after their last child. Your surgeon will talk through timing, recovery and hormone replacement with you.
Words you may hear
The terms that come up, in plain language
- Risk-reducing surgery
- An operation to remove healthy tissue that carries a high chance of becoming cancer. It lowers risk a great deal but does not remove it entirely.
- Salpingo-oophorectomy
- Removal of both fallopian tubes and both ovaries. The most common preventive operation for BRCA carriers.
- Surgical menopause
- Menopause that starts straight away after the ovaries are removed, rather than gradually. Hot flushes can be sudden and strong.
- Hormone replacement
- Medicine that replaces the hormones the ovaries made. Often suggested after early ovary removal if you have not had breast cancer.
- Egg or embryo freezing
- Storing eggs, or eggs fertilised with sperm, before surgery or treatment, to use later.
- Completed family
- The point at which a couple feels they do not want more children. Only you can decide when that is.
Side by side
Children first or ovary surgery first: the trade-offs
Children first, surgery later
Surgery first, children later
Natural pregnancy stays possible
Pregnancy needs frozen embryos or donor eggs
Cancer risk continues while you wait
Risk is lowered sooner
Extra screening is needed in the meantime
Ovarian screening is no longer needed
Menopause arrives at its natural time
Menopause starts straight away
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Being straight with you
What this page cannot tell you
It cannot tell you the right age for your surgery. That depends on your gene, your family history, any cancer you have already had and your own plans. Your surgeon and genetic counsellor will set it with you, and it may change as your life does.
It cannot interpret your result
Some variants carry a smaller risk than others, and a few genes raise breast risk without raising ovarian risk. What your specific variant means is a question for the counsellor who ordered the test, not for a search engine.
Who this does not apply to
If your report shows a variant of uncertain significance, preventive surgery is not usually recommended, and this page does not apply to you. The same is true if your family has cancer but testing found no fault. Most women who read about hereditary cancer will never need preventive surgery at all.
You can change your mind at any point before surgery. Choosing to wait is a legitimate choice.Commonly believed
Four things women tell us, and what is actually true
"Having children first means taking a huge risk."
Many carriers complete their family before surgery, with closer screening in the meantime. Risk does rise with age, which is why timing is discussed carefully. A planned delay for a family is a common, accepted path.
"If my breasts are removed, I cannot have children."
Mastectomy does not touch the ovaries or the womb. Pregnancy is just as possible afterwards. The only change is that the removed breasts cannot make milk.
"Once my ovaries are removed, I can never carry a baby."
If the womb is kept, pregnancy is still possible using embryos frozen before surgery, or donor eggs. It needs IVF and careful planning, but it can be done.
"Pregnancy itself is dangerous for a BRCA carrier."
The evidence here is mixed and comes mostly from observational studies. It has not led guidelines to advise carriers against pregnancy. Your counsellor can explain what is known for your gene.
Questions we are asked
Common questions about pregnancy and preventive surgery
At what age is ovary removal usually advised?
It depends on the gene. For BRCA1 it is usually advised earlier than for BRCA2, and for some other genes later still. Guidelines give an age range rather than a single birthday. Your counsellor will tell you the range for your gene and how your family history shifts it.
Can I get pregnant after a preventive mastectomy?
Yes. A mastectomy does not affect the ovaries or the womb, so fertility is unchanged. You will not be able to breastfeed from the removed breasts. If only one breast was removed, feeding from the other is often possible.
Should I freeze eggs before ovary removal?
If there is any chance you want children after surgery, it is worth discussing. Freezing needs a short course of hormone injections, so ask your oncologist whether that is safe for you, especially if you have had breast cancer.
Can embryos be tested for the family fault?
Yes, through IVF with preimplantation testing, often called PGT-M. It is offered at some fertility centres in India, including in Hyderabad. It is a separate decision from surgery, and a counsellor can explain the two together.
What screening do I need while I wait?
Breast screening usually starts early and may include MRI. For the ovaries, no test has been shown to find cancer early enough to rely on, which is why surgery is advised. Your team will explain what they can offer and its limits.
Will I need hormone replacement after surgery?
If your ovaries are removed well before natural menopause and you have not had breast cancer, hormone replacement is often suggested to protect bones and heart. It is usually continued until around the age natural menopause would have come.
My family wants children soon, but I am not ready. What now?
That is common. A counsellor can meet you alone first, then with your partner or parents if you wish. Many families find it easier to hear the medical reasons from a professional than from their own daughter or daughter-in-law.
Who should I talk to first?
Start with a genetic counsellor, who can explain your gene and your options. They will bring in a gynaecologist or breast surgeon when surgery is being considered. Call the CION helpline if you are unsure where to begin, and someone will point you to the right clinic.
Your Specialists
Meet CION's oncologists. Bring your family history or genetic report to them.
Our medical oncologists see people with a strong family history of cancer, arrange genetic counselling and testing where it fits, and plan the checks that follow.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
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Sources
- National Cancer Institute — BRCA Gene Changes: Cancer Risk and Genetic Testing Fact Sheet
- GeneReviews (NCBI) — BRCA1- and BRCA2-Associated Hereditary Breast and Ovarian Cancer
- National Cancer Institute — Surgery to Reduce the Risk of Breast Cancer
- Human Fertilisation and Embryology Authority — Egg freezing
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Fertility preservation for gene carriersFreezing eggs or embryos before surgery, explainedTiming pregnancy around cancer treatmentIf you have already had cancer, the other gap to planPreimplantation genetic testing (PGT-M) explainedTesting embryos so a child does not inherit the faultGenetic risk and arranged marriage conversationsHow families raise a result before a marriage
Talk to us
Trying to fit a family around preventive surgery?
Tell us your gene result and your family plans. We will arrange for a counsellor and the right surgeon to talk the timing through with you, without any rush. One helpline serves every CION centre.