Should Breast and Plastic Surgeons Send Breast Reduction Specimens for Analysis

Should Breast and Plastic Surgeons Send Breast Reduction Specimens for Analysis?

Reduction mammaplasty or breast reduction is a common procedure that can give a functional and aesthetic improvement for patients.

Patients often present with neck / back pain and discomfort due to the relative size of their breasts which can also affect posture. Reduction of tissue can be performed not only to improve symptoms but also to lift the nipple and provide a better aesthetic shape.

It is important for patients undergoing breast reduction to remember that although surgery is a functional and aesthetic procedure there is an incidence of occult (undetected) breast disease / cancer. Breast screening is not 100% sensitive / specific and although rare even patients who have been reassured following breast screening may have occult disease. All patients undergoing breast reduction surgery need to be consented appropriately.

Women with benign breast disease, typically found in reduction mammaplasty specimens are at a higher risk of breast cancer and this has implications for patients in terms of breast surveillance.

A recent study from Finland analysed 918 women who underwent reduction mammaplasty from January 2007 to December 2011 and found abnormal histopathological findings in 88 (10%) patients. They found that patients with abnormal histopathology were older, and the specimens were heavier.

They concluded that preoperative diagnostics and demographics did not sufficiently detect malignant or cancer risk and recommended that histopathological analysis of reduction mammaplasty specimens.

Mr Ross has always believed that any tissue removed from a patient should be sent for histological diagnosis. He routinely sends breast reduction specimens for analysis. On only one occasion has Mr Ross encountered an abnormal finding and in this scenario the patient required no further surgery but required ongoing breast surveillance.

Mr Ross believes in providing optimal outcomes for patients but that any aesthetic or cosmetic surgery should not compromise patient safety. Having performed many oncoplastic breast cases including mastectomies and reconstructions Mr Ross always performs breast reductions and mastopexy surgery in a way that would not compromise patients long term should an abnormality be detected following breast reduction surgery.


Reference

Merkkola-von Schantz PA1, Jahkola TA2, Krogerus LA3, Hukkinen KS4, Kauhanen SM2. Should we routinely analyze reduction mammaplasty specimens? J Plast Reconstr Aesthet Surg. 2016 Nov 10. S1748-6815(16)30469-7.