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Breast Capsulectomy Specimens and Their Clinical Implications

Roth, Forrest S. M.D.; Felder, John M. M.D.; Friedman, Jeffrey D. M.D.

Plastic and Reconstructive Surgery: December 2010 - Volume 126 - Issue 6 - p 1848-1852
doi: 10.1097/PRS.0b013e3181f4463c
Breast: Original Articles

Background: Plastic surgeons routinely submit breast capsulectomy surgical specimens for pathologic evaluation. However, clinically significant findings are rarely identified. In an effort to reduce health care costs and the unnecessary use of hospital resources, this study reviews the efficacy of submitting breast capsulectomy specimens for pathologic examination.

Methods: All patients from The Methodist Hospital in Houston, Texas, during the years 2000 to 2008 who underwent breast capsulectomy were selected for by Current Procedural Terminology codes 19370 and 19371 (open periprosthetic capsulotomy and periprosthetic capsulectomy of the breast, respectively). A total of 264 patients qualified for the study, and their pathology reports were reviewed.

Results: The pathology reports of 434 capsulectomy specimens in 264 patients revealed benign capsules in 206 patients (78.0 percent). Additional findings, including inflammation, calcification, granuloma, and necrosis, were identified in an additional 57 patients (21.6 percent). One patient (0.4 percent) had carcinoma identified within a breast capsule. This was a patient known preoperatively to have recurrent invasive ductal carcinoma that extended into the surrounding capsule. Therefore, none of the 264 capsulectomy specimens revealed new neoplasms, occult disease, or other clinically significant findings that changed the patient's postoperative treatment.

Conclusions: No clinically significant findings were identified in this review of breast capsulectomy specimens in 264 patients. However, the cost for such pathologic examinations was substantial. In an effort to reduce health costs and the unnecessary use of hospital resources, breast capsulectomy specimens may not necessarily need to be routinely submitted for surgical pathologic evaluation.

Houston, Texas

From Baylor College of Medicine and the Methodist Institute for Reconstructive Surgery.

Received for publication September 20, 2009; accepted May 20, 2010.

Presented at the 88th Annual Meeting and Aesthetic Symposium of the American Association of Plastic Surgeons, in Rancho Mirage, California, March 21 through 24, 2009.

Disclosure: No funds were used to support this work. The authors have no financial interest to declare.

Jeffrey D. Friedman, M.D., Methodist Institute for Reconstructive Surgery, 6560 Fannin, Suite 2200, Houston, Texas 77030,

©2010American Society of Plastic Surgeons