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Proliferative Lesions Found at Reduction Mammaplasty: Incidence and Implications in 995 Breast Reductions

Mastroianni, Melissa, M.D.; Lin, Alex, M.D.; Hughes, Kevin, M.D.; Colwell, Amy S., M.D.

Plastic and Reconstructive Surgery: February 2019 - Volume 143 - Issue 2 - p 271e-275e
doi: 10.1097/PRS.0000000000005192
Breast: Original Articles
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Background: Reduction mammaplasty relieves symptomatic macromastia. Pathologic specimens occasionally reveal unsuspected proliferative lesions or carcinoma. Few studies examine the incidence, risk factors, and outcomes in this population.

Methods: A retrospective review was performed between 2000 and 2012. The pathologic condition was categorized as benign, proliferative, or cancer.

Results: Five hundred seventy-two patients underwent 995 reduction mammaplasties. Cancer was detected in 23 specimens (2.3 percent) and proliferative lesions were detected in 137 (13.8 percent). Compared with patients with benign pathologic findings, patients with proliferative lesions or cancer were older (p < 0.001), had greater body mass index (p = 0.003), had increased unilateral procedures (p < 0.001), and more had history of cancer (p < 0.001). On multivariable regression analysis, age (OR, 1.058; 95 percent CI, 1.040 to 1.077; p < 0.001) and prior breast cancer (OR, 2.070; 95 percent CI, 1.328 to 3.227, p = 0.001) were independent risk factors for proliferative lesions, and age significantly predicted cancer (OR, 1.054; 95 percent CI, 1.012 to 1.097; p = 0.010). Forty-one percent of patients with proliferative lesions and no history of cancer had a change in management. If there was a history of cancer, 54 percent had a change in management.

Conclusions: Proliferative lesions of the breast may be more common than previously reported. Age and a history of breast cancer increase the risk for proliferative lesions. All should be referred to oncology, as nearly half of these patients will have a change in management.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.

Boston, Mass.

From the Division of Plastic and Reconstructive Surgery and Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School.

Received for publication February 19, 2018; accepted June 27, 2018.

Presented at the 96th Annual Meeting of the American Association of Plastic Surgeons, in Austin, Texas, March 25 through 28, 2017.

Disclosure:The authors have no relevant financial relationships to disclose. This work was not supported by any sources of external funding.

Amy S. Colwell, M.D., Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, WACC 435, Boston, Mass. 02214, acolwell@mgh.harvard.edu

Copyright © 2018 by the American Society of Plastic Surgeons