Mammographic Changes After Oncoplastic Reduction Mammaplasty

BACKGROUND:

Reconstruction of partial lumpectomy defects with reduction mammaplasty techniques can improve aesthetic outcomes.  However, the impact of the significant tissue rearrangement on post-operative mammographic findings and subsequent recommendations for biopsy has not been well-studied.

METHODS:

A retrospective review of 50 patients who underwent partial mastectomy with immediate oncoplastic reduction mammaplasty reconstruction from 2001 to 2008 was performed.  Mammography reports at 6 months, 1 year, 2 years, and 3 years post-operatively were reviewed for Breast Imaging Reporting and Data System (BI-RADS) scores, predominant findings, and recommendations for subsequent imaging or biopsy.

RESULTS:

At six months post-operatively, 49 patients (98%) had benign findings of post-surgical changes, while one patient had microcalcifications and underwent subsequent surgical re-excision with residual DCIS on pathologic analysis. At one year, 94% of patients continued to have benign mammograms; of these mammograms, 94% reported only post-surgical scarring, while 6% described benign-appearing scattered or dystrophic calcifications.  Of the three patients with suspicious mammograms at one year, all underwent core biopsies with benign results.  At two years, rates of fat necrosis (2%) and scattered or dystrophic calcifications (10%) increased, though all mammographic findings were considered benign and none required additional imaging or biopsies.  By three years post-operatively, an additional two patients (4%) developed suspicious findings and underwent biopsies confirming local recurrence (one invasive, one in situ). The remaining 96% continued to have benign mammographic findings and were subsequently followed with routine biannual mammographic surveillance.

Overall, 88% of patients required no additional intervention in the three-year period following oncoplastic reduction mammaplasty.  Of patients recommended for biopsy, malignancy was discovered in 50%, including two local recurrences (4% of total patients).  This data is similar to a previously published large study (1841 women) of mammographic surveillance after partial mastectomy without oncoplastic reconstruction at our institution, which found a 6% malignancy rate at 5 years¹.

CONCLUSIONS:

Although substantial tissue rearrangement is performed at the time of oncoplastic reduction mammaplasty, our results demonstrate low rates of abnormal post-operative mammograms and subsequent biopsies over the first three years following the procedure.  These findings support the use of oncoplastic reduction mammaplasty as a strategy for improving reconstructive outcomes in patients undergoing partial mastectomy.