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Breast Reduction in Patients with Prior Breast Irradiation: Outcomes Using a Central Mound Technique

Weichman, Katie E. M.D.; Urbinelli, Leo M.D.; Disa, Joseph J. M.D.; Mehrara, Babak J. M.D.

Plastic and Reconstructive Surgery: May 2015 - Volume 135 - Issue 5 - p 1276–1282
doi: 10.1097/PRS.0000000000001147
Breast: Original Articles
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Coding Perspective

Background: Breast reduction in patients with a history of lumpectomy and irradiation is controversial because of a heightened risk of infection and wound healing complications. Persistent macromastia or asymmetry remains a problem in this patient population that is commonly not addressed. The authors studied the safety and efficacy of a central mound technique with minimal dissection for breast reduction or mastopexy in patients with a history of breast irradiation.

Methods: A case-control study of all patients undergoing bilateral breast reduction mammaplasty between 2008 and 2013 at Memorial Sloan Kettering Cancer Center was conducted. Patients who had unilateral breast irradiation and bilateral reduction using the central mound technique were included. Each patient had a control breast and an irradiated breast. Complications and outcomes were analyzed.

Results: Thirteen patients were included for analysis. Their average age was 50.23 ± 9.9 years, and average time from irradiation to breast reduction mammaplasty was 41.3 ± 48.5 months (range, 9 to 132 months). The average specimen weight of irradiated breasts was less than that of control breasts; however, this failed to reach statistical significance (254.2 ± 173.5 g versus 386.9 ± 218.5 g; p = 0.099). One patient developed fat necrosis in the previously irradiated breast and underwent biopsy. There was no incidence of nipple necrosis or breast cancer in either irradiated or nonirradiated breasts.

Conclusions: Breast reduction mammaplasty in patients who have had irradiation is feasible and can be performed safely in select cases. The central mound technique provides reliable and reproducible results and should be considered in patients with macromastia/asymmetry and a history of irradiation.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Coding Perspective for this article is on page 1281.

New York, N.Y.

From the Department of Surgery, Division of Plastic and Reconstructive Surgery, Memorial Sloan Kettering Cancer Center; and the Department of Plastic Surgery, New York University Langone Medical Center.

Received for publication August 2, 2014; accepted October 29, 2014.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. No external funding was received.

Babak J. Mehrara, M.D., Weill Cornell University Medical Center, 1275 York Avenue, Suite MRI 1006, New York, N.Y. 10065, mehrarab@mskcc.org

©2015American Society of Plastic Surgeons