Reduction mammaplasty is a safe, effective option that relieves physical and psychosocial symptoms in adolescent and young adult patients with macromastia. However, little is known about the incidence, significance, or appropriate management of incidental abnormal breast pathology identified in pediatric patients. This study aims to characterize incidental pathologic findings of adolescent and young women undergoing reduction mammaplasty and guide management of young patients with incidental breast tissue abnormalities. Data were obtained from a retrospective chart review of 798 adolescent and young adult women who underwent unilateral or bilateral reduction mammaplasty at Boston Children’s Hospital between June 2010 and May 2018. Charts were reviewed for patient demographics, indication for surgery, relevant medical history, relevant family history, medications, breast cancer risk factors, type of surgery, reduction mammaplasty specimen weight, and histologic findings. Mean age at surgery was 17.5 years (range, 11–24 years). Indications for surgery included bilateral macromastia (94.9%), breast asymmetry (4.9%), and juvenile breast hypertrophy (0.3%). Patients (87.2%) had breast tissue without significant histopathologic change. Among the remaining 12.8%, findings included benign, nonproliferative lesions (eg, fibrocystic change, ductal ectasia) in 7.4% and proliferative lesions without atypia (eg, fibroadenoma, fibroadenomatoid change, pseudoangiomatous stromal hyperplasia) in 7.4%. Five patients (0.6%) had proliferative lesions associated with increased risk for invasive carcinoma, including 4 (0.5%) with atypical ductal hyperplasia and 1 (0.1%) with focal atypical hyperplasia. Patients with atypical proliferative lesions ranged from 14 to 19 years old, and none had a personal history of cancer, first-degree family history of breast cancer, or known history of BRCA mutation. Among all women who undergo reduction mammaplasty, prevalence of incidental overt carcinoma and high-risk proliferative lesions are low, with the largest study to date reporting 0.79% and 6.26%, respectively.1 Our findings are lower than those reported in older women, as expected. The low rate of overt breast carcinoma in young women has caused some to advocate against routine pathologic evaluation of reduction mammaplasty specimens. However, young women with atypia may have a greater risk of developing breast cancer relative to older women with atypia, and women who develop breast cancer before 35 years old tend to have more aggressive disease.2,3 The 5 young women with incidental atypical proliferative findings had no risk factors that would have otherwise stratified them for more rigorous breast cancer surveillance. Thus, the value of detecting incidental proliferative lesions in young women may lie in identifying those with an increased risk of developing invasive and/or biologically aggressive disease, facilitating earlier and more rigorous screening.
1. Acevedo F, Armengol VD, Deng Z, et al. Pathologic findings in reduction mammaplasty specimens: a surrogate for the population prevalence of breast cancer and high-risk lesions. Breast Cancer Res Treat. 2018;173:201–207.
2. Degnim AC, Visscher DW, Berman HK, et al. Stratification of breast cancer risk in women with atypia: a Mayo cohort study. J Clin Oncol. 2007;25:2671–2677.
3. Colleoni M, Rotmensz N, Robertson C, et al. Very young women (<35 years) with operable breast cancer: features of disease at presentation. Ann Oncol. 2002;13:273–279.