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Carcinoma and Atypical Hyperplasia in Reduction Mammaplasty: Increased Sampling Leads to Increased Detection. A Prospective Study

Ambaye, Abiy B. M.D.; MacLennan, Susan E. M.D.; Goodwin, Andrew J. M.D.; Suppan, Thomas M.D.; Naud, Shelly Ph.D.; Weaver, Donald L. M.D.

Plastic and Reconstructive Surgery: November 2009 - Volume 124 - Issue 5 - p 1386-1392
doi: 10.1097/PRS.0b013e3181b988da
Breast: Original Articles

Background: Reduction mammaplasty for symptomatic macromastia or correction of asymmetry is performed more than 100,000 times per year in the United States. The reported incidence of occult breast cancer in reduction mammaplasty ranges from 0.06 to 4.6 percent. No standard pathology assessment for reduction mammaplasty exists. The authors evaluated the incidence of occult carcinoma and atypical hyperplasia in reduction mammaplasty specimens and identified clinical risk factors. Systematic sampling of additional tissue sections was instituted to evaluate the hypothesis that increased sampling would identify more significant pathologic findings.

Methods: All reduction mammaplasty 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 significant pathologic findings (carcinoma and atypical hyperplasia) was tabulated. Variables such as age and preoperative mammogram were examined.

Results: A total of 202 cases were evaluated. Significant pathologic findings (carcinoma and atypical hyperplasia) were present in 12.4 percent. The rate of carcinoma was 4 percent in all patients (6.2 percent in patients ≥40 years and 7.9 percent in patients ≥50 years).

Conclusions: A significantly higher rate (12.4 percent) of significant pathologic findings was identified in this prospective study compared with published literature. None of the lesions was identified on preoperative mammogram. Age was significantly associated with significant pathologic findings. Increased sampling was associated with significant pathologic findings only in patients 40 years or older, indicating the need for thorough sampling of reduction mammaplasty specimens in patients older than 40.

Burlington, Vt.

From the Departments of Pathology and Plastic and Reconstructive Surgery and the Vermont Cancer Center, University of Vermont.

Received for publication January 29, 2009; accepted April 2, 2009.

Presented in part at the 30th Annual San Antonio Breast Cancer Symposium, in San Antonio, Texas, December 13 through 16, 2007.

Disclosure: The authors have no commercial or financial associations to disclose.

Abiy B. Ambaye, M.D., Department of Pathology, ACC EP2, 152, Fletcher Allen Health Care, University of Vermont, 111 Colchester Avenue, Burlington, Vt. 05401,

©2009American Society of Plastic Surgeons