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Clockwise Pattern Pathologic Examination in Breast Reduction Mammaplasty

Long, Xiao M.D.; Qiao, Qun M.D.; Zhao, Ru M.D.

Author Information
Plastic and Reconstructive Surgery: April 2012 - Volume 129 - Issue 4 - p 757e-758e
doi: 10.1097/PRS.0b013e318245e8a1
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We have benefited greatly from several articles published in Plastic and Reconstructive Surgery concerning breast cancer and reduction mammaplasty.1,2 We have also noticed the higher morbidity of breast cancer among Chinese patients in our clinical work. Although some doctors have questioned the price of the diagnostic test compared with the low cancer occurrence rate,3 we still believe it is effective for detecting occult breast cancer among patients undergoing reduction mammaplasty.

Combined with radiotherapy and chemotherapy, breast-conserving surgery has been proven to be an effective method of treating early-stage breast cancer. During the tissue reshaping of breast reduction, a significant amount of intraoperative adjustment is required both in terms of removing tissue and in terms of reshaping tissue to obtain the best result. Thus, when breast cancer is detected, surgeons have no idea about the location of the tumor, and mastectomy is usually the result. However, most of the tumors that cannot be detected by ultrasound and radiography preoperatively are in the early stage.

To clarify the tumor location, we have established a simply performed method of locating all of the specimens during breast reduction surgery. Pathologic specimens were sent for frozen pathologic evaluation according to the “clockwise” pattern (Fig. 1). Once cancer is detected, the patient will undergo breast-conserving surgery according to the tumor site and reduction method.

Fig. 1
Fig. 1:
Specimens during the operation.

According to the national standard price of the diagnostic test in China, each specimen will cost $15 (¥100). For most patients, it will cost $120 to $150 more to receive such a detailed, thorough pathologic test. If cancer is detected, all of the fees will be covered by the medical insurance. Thus, clockwise pattern pathologic examination has been used widely in our clinical work and successfully helps physicians to locate the tumor and ensure that the patient undergoes skin-sparing breast resection even if cancer is detected.

Xiao Long, M.D.

Qun Qiao, M.D.

Ru Zhao, M.D.

Division of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, Beijing, People's Republic of China


1. Hage JJ, Karim RB. Risk of breast cancer among reduction mammaplasty patients and the strategies used by plastic surgeons to detect such cancer. Plast Reconstr Surg. 2006;117:727–735; discussion 736.
2. Clark CJ, Whang S, Paige KT. Incidence of precancerous lesions in breast reduction tissue: A pathologic review of 562 consecutive patients. Plast Reconstr Surg. 2009;124:1033–1039.
3. Koltz PF, Girotto JA. The price of pathology: Is screening all breast reduction specimens cost effective? Plast Reconstr Surg. 2010;125:1575–1576; author reply 1576–1577.


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