Abstract
Background: Reduction mammaplasty (RMP) for symptomatic macromastia or correction of asymmetry is performed more than 100,000 times per year in the USA. The reported incidence of occult breast cancer in RMP ranges from 0.06% to 4.6%. No standard pathology assessment for RMP exists. The purpose of this prospective study was to evaluate the incidence of occult carcinoma and atypical hyperplasia in RMP specimens and to identify clinical risk factors that might predict for the presence of these high risk breast diseases. Additionally, systematic sampling of additional tissue sections was instituted in order to evaluate the hypothesis that increased sampling would identify more significant pathologic findings (SPF).
Methods: All RMP specimens over a 20-month period at a single institution were prospectively examined. All specimens had baseline gross and microscopic evaluations, and then each was subjected to systematic additional sampling. The incidence of SPF (carcinoma and atypical hyperplasia) was tabulated, and variables such as age and presence of preoperative mammogram were examined.
Results: A total of 202 cases were evaluated. Significant pathologic findings (SPF), i.e. carcinoma and atypical hyperplasia, were present in 12.4% of patients. The rate of carcinoma was 4% in all patients, 6.2% in patients 40 years or older and 7.9% in patients 50 years or older.
Conclusion: A significantly higher rate (12.4%) of SPF was identified in this prospective study compared to published literature. None of the lesions were identified on preoperative mammogram. Age was significantly associated with SPF. Increased sampling was associated with SPF only in patients 40 years or older, indicating the need for thorough sampling of RMP specimens in patients older than 40.