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A risk-stratified comparison of incidental findings in reduction mammoplasty
Stephanie E. Dreifuss, MD, Carolyn De La Cruz, MD.
University of Pittsburgh, Pittsburgh, PA, USA.

A risk-stratified comparison of incidental findings in reduction mammoplasty
Background: Reduction mammoplasty is indicated for symptomatic macromastia or for breast asymmetry following contralateral breast cancer surgery. Previous studies have compared the incidence of occult malignancy or atypical lesions in resection specimens between these two groups. However, no studies have compared incidentally found lesions in breast reduction specimens based on relative risk of future breast cancer. Our ten-year study stratifies incidental lesions by relative risk of malignant progression and compares the frequency of these findings in bilateral reduction mammoplasty for symptomatic macromastia versus unilateral reduction mammoplasty for symmetry in oncologic cases.
Methods: Charts were reviewed from 422 patients undergoing breast reductions by a single surgeon over a 10-year period. Data collected include age, procedure, specimen weight, and histologic findings. Pathologic data was stratified based on relative risk of malignant progression (benign, RR=1.0; proliferative, RR=1.1-2.0; atypical, RR>2.1; carcinoma in situ; invasive cancer). The frequency of findings from each of these risk groups was compared between patients with and without cancer history.
Results: 305 patients underwent bilateral reduction mammoplasty for macromastia. 117 patients underwent unilateral reduction mammoplasty for symmetry in cases of contralateral malignancy. Patients without a history of malignancy had a higher incidence of benign lesions (61.6% vs. 50.4%, p=0.02). Both groups had a similar incidence of proliferative lesions (30.7% vs. 30.8%, p=0.48). Patients with a history of contralateral malignancy had a higher incidence of atypical lesions (12.0% vs. 7.2%, p=0.05) and carcinoma in situ (6.0% vs. 0.3%, p<0.01). There was one patient in the unilateral breast reduction group who had an incidentally found invasive carcinoma.
Conclusions: Patients undergoing unilateral breast reduction for symmetry following oncologic resection with or without reconstruction have a higher incidence of atypical and cancerous lesions versus those undergoing reduction mammoplasty for symptomatic macromastia. Though other groups have looked at incidental findings in patients undergoing elective versus reconstructive reduction mammoplasty, no group has compared the incidental findings stratified by risk. Our findings underscore the importance of pathologic analysis of breast reduction specimens for early detection of high-risk and malignant lesions. Furthermore, this data will prove valuable for preoperative counseling prior to reduction mammoplasty for either of these indications.


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