Abstract
Background
Reduction mammoplasty (RM) continues to be popular. The reported incidence of occult breast carcinoma in these specimens varies between 0.05 and 1.8 %. Literature review reveals a wide discrepancy in study methodology, outcome measures, and even what is constituted as a “significant” result. We set out to identify RM patients at increased risk of occult significant pathological findings to engender a systematic improvement in efficiency of those specimens sent for histopathological examination.
Methods
A single-centre retrospective study of the pathology results for 1,388 consecutive RM patients was undertaken. Patients were divided into three groups according to indication for surgery: group 1, macromastia; group 2, developmental asymmetry; and group 3, symmetrising surgery after breast cancer reconstructive surgery.
Results
Nine cases of occult carcinoma were found among the 1,388 women (0.65 %), all in patients over 35 years of age. Forty percent of all patients were under 35 years old. Histopathological analysis of 59 % of patients revealed nonsignificant findings. Patients with a breast cancer history were 4.3 times more likely to have occult breast cancer. Patients under 30 years of age had a significantly higher chance of nonsignificant findings than those over 30 (relative risk = 2.5).
Conclusions
Although the overall incidence of occult breast cancer in reduction mammaplasty patients remains low, specific subgroups with a higher risk are identified. It is recommended that histological analysis of specimens should be restricted to high-risk patients and those over 30 years of age as significant pathology is uncommon in younger patients. These results will promote health-care-related economic benefits and a reduction of the burden placed on histopathology departments.
Level of Evidence IV
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References
American Society for Aesthetic Plastic Surgery, Top 5 surgical procedures (2010). http://www.surgery.org/sites/default/files/2010-top5.pdf. Accessed 23 Feb 2012
Kerrigan CL, Collins ED, Striplin D (2001) The health burden of breast hypertrophy. Plast Reconstr Surg 108:1591–1599
Cancer Research UK, Breast cancer—UK incidence statistics (2011). http://info.cancerresearchuk.org/cancerstats/types/breast/incidence/. Accessed 23 Feb 2011
Titley OG, Armstrong AP, Christie JL, Fatah MF (1996) Pathological findings in breast reduction surgery. Plast Surg 49(7):447–451
NHS Cancer Screening Programmes jointly with The Royal College of Pathologists (2005) Pathology of reporting breast disease, NHSBSP Publication No. 58. http://www.cancerscreening.nhs.uk/breastscreen/publications/nhsbsp58-low-resolution.pdf. Accessed 23 Feb 2011
Karabela-Bouropoulou V, Liapi-Avgeri G, Iliopoulou E, Agnantis NJ (1994) Histological findings in breast tissue specimens from reduction mammoplasties. Pathol Res Pract 190(8):792–798
Koltz PF, Girotto JA (2010) The price of pathology: Is screening all breast reduction specimens cost effective? Plast Reconstr Surg 125(5):1575–1576 author reply 1576–1577
Snyderman RK, Lizardo JG (1960) Statistical study of malignancies found before, during, or after routine breast plastic operations. Plast Reconstr Surg Transpl Bull 25:253–256
Pitanguy I, Torres ET (1964) Histopathological aspects of mammary gland tissue in cases of plastic surgery of breast. Br J Plast Surg 17:297–302
Viana GA, Pitanguy I, Torres E (2005) Histopathological findings in surgical specimens obtained from reduction mammaplasties. Breast 14(3):242–248
Tang CL, Brown MH, Levine R, Sloan M, Chong N, Holowaty E (1999) Breast cancer found at the time of breast reduction. Plast Reconstr Surg 103(6):1682–1686
Boice JD Jr, Persson I, Brinton LA, Hober M, McLaughlin JK, Blot WJ, Fraumeni JF Jr, Nyrén O (2000) Breast cancer following breast reduction surgery in Sweden. Plast Reconstr Surg 106(4):755–762
Crikelair GF, Malton SD (1959) Mammaplasty and occult breast malignancy: case report. Plast Reconstr Surg Transpl Bull 23(6):601–606
Rees TD, Coburn R (1972) Breast reduction: Is it an aid to cancer detection? Br J Plast Surg 25(2):144–146
Gottlieb JR, McKinney P, Walkinshaw MD, Sperling RL (1989) Occult breast carcinoma in patients undergoing reduction mammaplasty. Aesthet Plast Surg 13(4):279–283
Petit JY, Rietjens M, Contesso G, Bertin F, Gilles R (1997) Contralateral mastoplasty for breast reconstruction: a good opportunity for glandular exploration and occult carcinomas diagnosis. Ann Surg Oncol 4(6):511–515
Ricci MD, Munhoz AM, Pinotti M, Geribela AH, Teixeira LC, Aldrighi C et al (2006) The influence of reduction mammaplasty techniques in synchronous breast cancer diagnosis and metachronous breast cancer prevention. Ann Plast Surg 57(2):125–132 discussion 133
Hennedige AA, Kong TY (2009) Gandhi A (2011) oncological screening for bilateral breast reduction: a survey of practice variations in UK breast and plastic surgeons. J Plast Reconstr Aesthet Surg 64(7):878–883
The Royal College of Pathologists (2005) Histopathology and cytopathology of limited or no clinical value, 2nd edn. http://www.rcpath.org/resources/pdf/HOLNCV-2ndEdition.pdf. Accessed 23 Feb 2011
Cook IS, Fuller CE (2004) Does histopathological examination of breast reduction specimens affect patient management and clinical follow up? J Clin Pathol 57(3):286–289
Jansen DA, Murphy M, Kind GM, Sands K (1998) Breast cancer in reduction mammoplasty: case reports and a survey of plastic surgeons. Plast Reconstr Surg 101(2):361–364
Ishag MT, Bashinsky DY, Beliaeva IV, Niemann TH, Marsh WL Jr (2003) Pathologic findings in reduction mammaplasty specimens. Am J Clin Pathol 120(3):377–380
Colwell AS, Kukreja J, Breuing KH, Lester S, Orgill DP (2004) Occult breast carcinoma in reduction mammaplasty specimens: 14-year experience. Plast Reconstr Surg 113(7):1984–1988
Kakagia D, Fragia K, Grekou A, Tsoutsos D (2005) Reduction mammaplasty specimens and occult breast carcinomas. Eur J Surg Oncol 31(1):19–21
Pitanguy I, Torres E, Salgado F, Pires Viana GA (2005) Breast pathology and reduction mammaplasty. Plast Reconstr Surg 115(3):729–734
Dotto J, Kluk M, Geramizadeh B, Tavassoli FA (2008) Frequency of clinically occult intraepithelial and invasive neoplasia in reduction mammoplasty specimens: a study of 516 cases. Int J Surg Pathol 16(1):25–30
Clark CJ, Whang S, Paige KT (2009) Incidence of precancerous lesions in breast reduction tissue: a pathologic review of 562 consecutive patients. Plast Reconstr Surg 124(4):1033–1039
Slezak S, Bluebond-Langner R (2011) Occult carcinoma in 866 reduction mammaplasties: preserving the choice of lumpectomy. Plast Reconstr Surg 127(2):525–530
Bondeson L, Linell F, Ringberg A (1985) Breast reductions: What to do with all the tissue specimens? Histopathology 9(3):281–285
Tulusan AH, Egger H, Schneider ML, Willgeroth F (1982) A contribution to the natural history of breast cancer. IV. Lobular carcinoma in situ and its relation to breast cancer. Arch Gynecol 231(3):219–226
White RR 4th (1998) Incidence of breast carcinoma in patients having reduction mammaplasty. Plast Reconstr Surg 102(5):1774–1775
Ozmen S, Yavuzer R, Latifoğlu O, Atabay K (2000) Coincidental breast carcinoma detection in reduction mammaplasty specimens. Plast Reconstr Surg 106(5):1219–1220
Dinner MI, Artz JS (1989) Carcinoma of the breast occurring in routine reduction mammaplasty. Plast Reconstr Surg 83(6):1042–1044
Fitzgibbons PL, Henson DE, Hutter RV, Cancer Committee of the College of American Pathologists (1998) Benign breast changes and the risk for subsequent breast cancer: an update of the 1985 consensus statement. Arch Pathol Lab Med 122(12):1053–1055
Lakhani SR (1999) The transition from hyperplasia to invasive carcinoma of the breast. J Pathol 187(3):272–278
Keleher AJ, Langstein HN, Ames FC, Ross MI, Chang DW, Reece GP, Singletary SE (2003) Breast cancer in reduction mammaplasty specimens: case reports and guidelines. Breast J 9(2):120–125
Snyderman RK (1990) Breast carcinoma found in association with reduction mammaplasty. Plast Reconstr Surg 85(1):153–154
Hage JJ, Karim RB (2006) Risk of breast cancer among reduction mammaplasty patients and the strategies used by plastic surgeons to detect such cancer. Plast Reconstr Surg 117(3):727–735
Perras C (1990) Fifteen years of mammography in cosmetic surgery of the breast. Aesthet Plast Surg 14(2):81–84
Campbell MJ, Clark CJ, Paige KT (2010) The role of preoperative mammography in women considering reduction mammoplasty: a single institution review of 207 patients. Am J Surg 199(5):636–640
Rudolph R, Niedbala AR (2003) Surgical management of the patient with invasive carcinoma discovered at reduction mammoplasty. Am Surg 69(11):1003–1005
National Health Service (2011) NHS Cancer Screening Programmes. Why are women under 50 not routinely invited for breast screening? http://www.cancerscreening.nhs.uk/breastscreen/under-50.html. Accessed 23 Feb 2011
National Health Service (2010) NHS breast screening programme. Annual review. http://www.cancerscreening.nhs.uk/breastscreen/publications/nhsbsp-annualreview2010.pdf. Accessed 23 Feb 2011
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Hassan, F.E., Pacifico, M.D. Should We Be Analysing Breast Reduction Specimens? A Systematic Analysis of Over 1,000 Consecutive Cases. Aesth Plast Surg 36, 1105–1113 (2012). https://doi.org/10.1007/s00266-012-9919-9
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DOI: https://doi.org/10.1007/s00266-012-9919-9