Long-Term Outcomes and Oncologic Implications of Histopathological Findings in Breast Reduction Specimens: A 15-Year Follow-Up Study.

[BACKGROUND] Breast reduction surgery provides both functional and aesthetic benefits and enables incidental detection of breast pathology. Although high-risk or malignant lesions are uncommon, their long-term clinical relevance remains unclear.

[OBJECTIVES] The aim of this study was to evaluate the histopathological findings of breast reduction specimens and assess their relationship with long-term breast outcomes, including the development of new breast disease and the need for subsequent biopsy or mastectomy.

[METHODS] This retrospective cohort study included 1349 patients (2630 breasts) who underwent breast reduction with a minimum 5-year follow-up. Long-term clinical outcomes were assessed only in the subset of 377 patients (731 breasts) who completed a follow-up questionnaire. Histopathological findings were classified into 3 risk categories according to their association with malignancy. A follow-up questionnaire assessed breastfeeding ability, adherence to imaging, and the occurrence of new breast masses or interventions. Associations between baseline risk category, follow-up duration, and long-term outcomes were analyzed using Pearson χ2 tests.

[RESULTS] High-risk or malignant lesions were identified in 1.3% of specimens, predominantly among women over 40 years. Specimen weight and previous contralateral breast cancer history were not associated with pathological risk. Among 731 breasts evaluated by questionnaire, 80.1% retained breastfeeding ability, whereas 38% reported no imaging follow-up. Biopsy incidence increased significantly with follow-up time (2.6%, 6.2%, and 13.8% at 5-10, 10-15, and >15 years; P < .001). Mastectomy rates also rose with time (0%, 0.6%, and 8.3%; P < .001), showing a trend toward higher incidence in baseline high-risk specimens.

[CONCLUSIONS] Breast reduction surgery facilitates incidental detection of high-risk lesions, particularly in women over 40 years. Higher baseline pathological risk and longer follow-up were associated with increased likelihood of mastectomy, underscoring the need for structured, risk-adapted surveillance to optimize long-term oncologic safety.