Comparison of mammography sensitivity after reduction mammoplasty targeting the glandular and fat tissue (original) (raw)
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Mammographic Findings Following Reduction Mammoplasty
Aesthetic Plastic Surgery, 2001
Breast reduction mammoplasty is becoming an increasingly common procedure. A baseline mammogram is recommended after 35 years of age as the most effective method for detection of small breast cancers. A prospective study was conducted for the evaluation of the mammographic findings after reduction mammoplasty. During the last 7 years, 113 patients over 35 years of age underwent bilateral reduction mammoplasty. All patients had a preoperative mammogram. A new mammogram was obtained at 6 and 18 months after the procedure. All films were reviewed by the same two radiologists. Breast reduction was performed with the vertical bipedicle flap technique (McKissock) and the inferior pedicle technique. There were no apparent differences in the findings between the two methods. Most common findings were parenchymal redistribution in 102 (90.2%) and elevation of the nipple in 96 (84.9%), produced by a shift of the breast tissue to a lower position. Calcifications were seen in 29 (25.6%), and "oil cysts" in 22 (19.4%), caused by localized fat necrosis. A retroareolar fibrotic band was found in 23 (20.3%), from the transposed flap. Areolar thickening was observed in six (5.3%), and skin thickening in only two (1.7%), from scar tissue. Mammographic findings after reduction mammoplasty are predictable, thus preventing unnecessary biopsies and making the diagnosis of lesions unrelated to the procedure easier. All patients over 35 years of age should have a preoperative and a postoperative mammogram for future reference.
Breast lesions in reduction mammaplasty specimens: a histopathological pattern in 534 patients
British journal of cancer, 2014
The prevalence of breast lesions (benign, precancerous and cancer lesions) in reduction mammaplasty (RM) specimens has rarely been reported in Europe and never in the Swiss population. Personal and histopathological data from 534 female patients who underwent RM were reviewed. Benign and/or malignant lesions were detected in 76.2% of all patients. Benign breast lesions associated with an increased risk of developing breast cancer represented 2.8% of all lesions. Breast cancer in situ was identified in 5 (0.9%) patients. Patient age and previous history of breast cancer were risk factors for incidental breast cancer. The rate of incidental carcinoma in situ was higher for patients with breast cancer history. Probably due to preoperative breast cancer investigation, no occult invasive breast cancer was found in reduction mammary specimens. Therefore before RM, breast cancer evaluation should be considered for all patients, especially for those with breast cancer risk factors (e.g., pa...
Approach to histopathological incidental lesions after reduction mammoplasty
European Journal of Plastic Surgery, 2019
Background The importance of analyzing tissue removed during reduction mammoplasty in healthy and asymptomatic patients has been emphasized in many publications. Pathological analysis can reveal many important findings that may be used to determine the patient's risk of breast cancer. Methods The pathology findings of patients who underwent reduction mammoplasty and mastopexy due to breast asymmetry and/or breast hypertrophy between January 1995 and May 2018 were analyzed retrospectively. Results A total of 283 women underwent breast reduction during the study period (560 breasts). Of all of the specimens, 273 had histopathological findings, most of which were fibrocystic breast tissue pattern (85.71%). In 11 specimens, 16 lesions considered proliferative in nature were detected. The mean follow-up period of the proliferative lesions was 6.1 years. No malignancy was observed during the follow-up period. Conclusions Age is not the only significant factor affecting pathology results. Risk factors should be determined and imaging findings should be considered as well. Every reduction mammoplasty procedure should be regarded as an opportunity for screening the breast tissue of the candidates. Level of evidence: Level IV, risk/prognostic study.
Breast cancer research and treatment, 2018
Mammoplasty removes random samples of breast tissue from asymptomatic women providing a unique method for evaluating background prevalence of breast pathology in normal population. Our goal was to identify the rate of atypical breast lesions and cancers in women of various ages in the largest mammoplasty cohort reported to date. We analyzed pathologic reports from patients undergoing bilateral mammoplasty, using natural language processing algorithm, verified by human review. Patients with a prior history of breast cancer or atypia were excluded. A total of 4775 patients were deemed eligible. Median age was 40 (range 13-86) and was higher in patients with any incidental finding compared to patients with normal reports (52 vs. 39 years, p = 0.0001). Pathological findings were detected in 7.06% (337) of procedures. Benign high-risk lesions were found in 299 patients (6.26%). Invasive carcinoma and ductal carcinoma in situ were detected in 15 (0.31%) and 23 (0.48%) patients, respective...
The Evaluation of Contralateral Breast Lesions in Breast Cancer Patients Using Reduction Mammoplasty
Purpose: This study evaluated the importance of routine pathological examination of contralateral breast specimens in breast cancer patients using reduction mammoplasty. Methods: The weight of breast tissue resected from the contralateral breast in 71 patients and the number of slices used for pathological evaluation were recorded. Breast lesions found in the contralateral breast and accompanying lesions with tumors were examined. Results: High risk proliferative lesions were reported in the contralateral breast of eight (11.2%) patients, and low-risk lesions were detected in 18 (25%). While the mean age of the patients with high-risk lesions was 45.6, it was 52.8 for the other patients (p=0.036). Conclusion: Bilateral reduction mammoplasty may be beneficial to delineate some pathologies in contralateral breasts even in those patients with normal clinical and radiological findings. The incidental discovery of these pathologies is much more likely in young breast cancer patients.
What we should know in mammography after reduction mammoplasty and mastopexy?
Breast Cancer, 2013
Background Reduction mammoplasty and mastopexy (breast lift surgery) are becoming increasingly common procedures. Knowledge of characteristic mammographic findings and imaging findings of breast cancer are important to interpret mammography in this population. Methods Patients undergoing a mammography examination between March 2006 and March 2012 were consecutively included. Seventy mammography examinations in 39 patients after reduction mammoplasty and 22 mammography examinations in 19 patients after mastopexy were reviewed and analyzed retrospectively. We compared the frequency of each characteristic mammographic finding between reduction mammoplasty and mastopexy. We also analyzed imaging findings of breast cancer in this population. Results The most frequent mammographic finding of the reduction mammoplasty was nipple elevation (84.3 %). Other findings included retraction of the lower breast (80 %), thickening of the skin (78.6 %), downward shifting of the glandular tissue (47.1 %), retroareolar fibrotic band (42.9 %), and areolar skin calcification or lipid cyst (35.7 %). The most frequent mammographic finding of mastopexy was thickening of the skin (72.7 %). Other mastopexy findings included elevation of nipple (68.2 %), areolar skin calcification or lipid cyst (36.4 %), retraction of lower position (31.8 %), and retroareolar fibrotic band (31.8 %). Downward shifting of glandular tissue and retraction of the lower portion have statistically lower frequency in mastopexy cases (P \ 0.05). Two breast cancers were diagnosed in reduction mammoplasty cases. One was missed and one was detected but difficult to diagnose using mammography. Conclusion Although mammography alone is not sufficient for breast screening after reduction mammoplasty, it may be possible to use mammography for postoperative follow-up after mastopexy only. So, operators should recognize that after reduction mammoplasty it will be hard to detect early breast cancer.
Incidental Lesions Detected in Reduction Mammoplasty Specimens
Indian Journal of Surgery, 2019
The incidence of breast lesions detected in reduction mammoplasty specimens varies with patients' previous history of breast cancer, patients' age, and the number of submitted pathological sections. The incidence of proliferative lesions with atypia including invasive carcinoma varies in different studies between 0.2% and 1.1%. In a retrospective review, 392 patients who underwent reduction mammoplasty mainly for symptomatic macromastia or breast symmetry were included in this study. All specimens of reduction mammoplasty were submitted for pathological examination and at least four tissue sections were taken for each breast. Among 392 patients, pathological examinations revealed proliferative lesions with atypia in 7 patients (1.7%) and invasive carcinoma in 1 patient (0.2%). Although proliferative lesions with atypia were found to increase in number compared with the patients under 40 years, there was no statistical significance found. Ductal in situ carcinoma was demonstrated in 1 patient (1%) younger than 40 years. Although there is no consensus formed for when to send mammoplasty specimens for pathological analysis or how many numbers of tissue sections to submit, we recommend routine pathological analysis of mammoplasty specimens and submitting at least four tissue sections regardless of patients' age.
European Journal of Cancer, 2012
Screening mammography Sensitivity Breast surgery Breast cancer Breast density Abstract Purpose: To study possible explanations for lower screening performance after previous benign breast surgery. Patients and methods: We included a consecutive series of 351,009 screening examinations in 85,274 women, obtained between January 1, 1997 and January 1, 2009. The examinations of women with screen detected cancers (SDC) or interval cancers (IC), diagnosed after previous benign breast surgery, were reviewed by two screening radiologists. They determined the presence and degree of post surgical changes, classified breast density and determined whether mammographic interpretation was hampered by tissue characteristics. They also assessed whether the cancer had already been visible at a previous screen. Results: Screening sensitivity was lower in women with prior benign breast surgery than without (63.5% (115/181) versus 73.5% (1643/2236), p = 0.004). A total of 115 SDCs and 66 ICs were diagnosed in breasts after previous benign breast surgery. Post surgical mammographic alterations in the breast segment where cancer was diagnosed were more distinct in ICs than in SDCs (p = 0.001). Women with post surgical mammographic changes at the location of the breast cancer had an increased interval cancer risk (OR = 2.12, 95% confidence interval (CI) = 1.05-4.26). Limited mammographic interpretation due to tissue characteristics was mentioned, only in three SDCs and one IC. The proportions of SDCs and ICS that were already visible at a previous screen were comparable for women with and without prior surgery (SDC: 47.5% versus 43.8%, p = 0.3, IC: 50.0% versus 48.4%, p = 0.8). Conclusion: Previous benign breast surgery decreases screening sensitivity and this is likely due to postoperative mammographic changes.
Is There Any Role of Reduction Mammoplasty in Decreasing Breast Cancer Risk in Gigantomastia?
Annals of Medical Research, 2022
Aim: Large breasts create psychological and physical problems in women, all of whom must also keep in mind the common problem of breast cancer. In the present study we examine the effect of breast reduction surgery on breast cancer risk. Materials and Methods: Our retrospective study is based on the records (between June 1, 2014, and June 30, 2019) of patients who underwent breast reduction surgery in the Plastic, Reconstructive and Aesthetical Surgery clinic of a training and research hospital. Statistical analyses were conducted using IBM SPSS Statistics (Version 25.0. Armonk, NY: IBM Corp.). Normal distribution of the data was analyzed with Kolmogorov-Smirnov. The data assessment included descriptive statistical methods and Kruskal-Wallis test. The results were evaluated at a 95% confidence interval and a significance level of p < 0.05. Results: Of the 134 patients included in the study, 47% were aged 36-50 years and 60.4% had a body mass index of ≥40. The shortest follow-up was 4 years, the longest follow-up was 9 years and the mean follow-up was 5.5 years. The mean amount of tissue removed from the right breast was 1050.54±484.90, the mean amount of tissue removed from the left breast was 1059.54±522.28, and the mean length of hospital stay was 1.15±0.74 days. The pedicle of choice was superomedial in 55.2% and the inverted-T scar technique was used in 66.4%. Definitive findings of neither in-situ nor invasive cancer were identified in any of the cases. Conclusion: Despite major sequelae such as external permanent scarring and decrease in breastfeeding and nipple sensation, breast reduction surgery is the operation that records the highest patient satisfaction in plastic, reconstructive and aesthetica surgery, as it provides physical and psychological relief by eliminating the heavy weight that affects the shoulders, back and neck. It is also known that the risk of breast cancer is decreased due to the removal of a considerable amount of breast tissue with cancer potential from the body, as well as the early diagnosis and treatment of incidentally detected cancer cases, albeit at a low rate. This is also supported by our findings.
Is it Necessary to Excise All Breast Lesions? Experience from a University-Based Breast Unit
Malaysian Family Physician
Background: Breast cancer is becoming more important in Asia since it affect the younger age group. Question arises whether it is safe for breast lesions to be left in-situ if all the elements in triple assessment are benign. The aim of this study is to audit all the excision biopsies of breast lumps done in the University Malaya Medical Centre (UMMC), to review the association of age with the type of pathological finding and to evaluate the rate of carcinoma in these biopsies. Methods: We conducted a retrospective study of all women who had excision biopsy of a breast lump in the University Malaya Medical Centre from January 2005 to December 2006. All patients with malignant preoperative biopsies were excluded. Results: Of 717 lesions in 664 patients, 459 (64%) were fibroadenoma, 114 (15.9%) were fibrocystic disease, 20 (2.8%) were phylloides tumour, 27 (3.8%) were papilloma, 59 (8.2%) were malignant and 38 (5.3%) were of other pathology. Of the 717 open biopsies, 449 (62.6%) had fine-needle aspiration cytology (FNAC), 31 (4.3%) had core needle biopsy (CNB), while 14 (2.0%) had both FNAC and CNB done prior to excision biopsy. 251 (35%) had neither FNAC nor CNB. The incidence of fibroadenoma decreased with increasing age and the incidence of fibrocystic changes and papilloma increased with increasing age. There was no association of age with phylloides tumour. The incidence of unexpected malignancy increased with increasing age. The incidence rates were 0.3%, 4.5%, 19.4%, 29.7% and 29.6% for the age group below 30, 30-39, 40-49, 50-59 and above 60 years of age respectively. Of the 59 malignant lesions, FNAC was performed on 47 (79.7%) and CNB on 16 (27.1%). 9 had both FNAC and CNB and 3 had neither FNAC nor CNB. Out of the 56 lesions where FNAC/CNB were done, 23 (41.1%) were reported as benign, 20 (35.7%) as suspicious, 4 (7.1%) as atypical, 5 (8.9%) as inadequate, 2 (3.6%) as equivocal and 2 (3.6%) as lymphoid lesions. Out of the 23 prior biopsies reported as benign, 22 were in the age group above 40. Conclusions: In conclusion, the rate of unexpected malignancy in open biopsies increases with age. It is recommended that all women above the age of 40 presenting with a palpable breast lump or a suspicious non-palpable abnormality on screening mammogram to have their lump excised even though the lump is benign on FNAC or CNB. However, women age of 30 to 39 should also have the lump excised in the presence of other risk factors such as family history of breast cancer.