Abnormal breast pathology after breast reduction surgery: A case-series and a 10-year retrospective chart review.

[BACKGROUND] Incidental abnormal breast pathology identified by histological analysis following breast reduction surgery is a rare complication. This may vary from benign and premalignant pathologies to invasive breast carcinoma. Such unexpected diagnoses can pose a challenge for plastic surgeons. Few studies have examined the treatment course for this patient population. We aimed to determine whether patients with incidental breast pathology following breast reduction mammoplasty were more likely to be treated conservatively or more aggressively through prophylactic mammoplasty.

[METHODS] A retrospective chart review was conducted for all patients who underwent bilateral breast reduction surgery over a 10-year period. The anatomical pathology reports from all breast reduction specimens were reviewed for abnormal breast pathology findings. For patients identified with abnormal breast pathology, health records were further assessed to determine their individualized course of management.

[RESULTS] A total of 694 patients met the inclusion criteria. Overall, 22 patients (3.2%) showed incidental findings of abnormal breast pathology. The most common incidental pathologies were ADH (n=9, 40.9%), followed by ALH (n=6, 27.3%), and LCIS (n=5, 22.7%). There was a single case of DCIS (4.5%), and a single case of lobular microinvasive carcinoma in one breast, which was found to be ER and PR positive (4.5%). Most patients were treated conservatively, with only four of the 22 patients undergoing a prophylactic mastectomy.

[CONCLUSIONS] The findings of this study suggest that prophylactic mastectomy is an uncommon intervention for abnormal breast pathology following breast reduction surgery. The majority of patients with low-grade breast lesions opted for a more conservative management plan.

[LEVEL OF EVIDENCE] IV.