Incidental Breast Carcinoma in Reduction Mammoplasty: A Systematic Review.

[BACKGROUND] Breast reduction is one of the most common plastic surgeries, with more than 40000 procedures performed in the United States annually. As breast reductions remove a portion of the breast and distort the anatomy, plastic surgeons need to be mindful of the possibility of breast cancer. In this study, we sought to review the available literature on breast cancer workup for patients undergoing reduction mammoplasties.

[METHODS] We queried the PubMed (National Institutes of Health) and Embase (Elsevier) databases to identify studies discussing breast cancer workup before breast reduction via preoperative imaging and/or at the time of surgery via histopathologic evaluation of breast specimens. Two individual reviewers screened the titles and abstracts for relevance. We extracted data on the outcomes of preoperative imaging and histopathologic evaluation of breast reduction specimens.

[RESULTS] Twenty-three articles published between 1996 and 2022 met the inclusion/exclusion criteria. Two studies evaluated only the role of preoperative imaging and reported a biopsy rate of 3.7% to 5.1% based on imaging findings. Three studies discussed only the role of histopathologic evaluation without mentioning the preoperative imaging requirements from the patients. For the remaining 18 studies, the rate of incidental breast cancer from breast reduction specimens was 0.0% to 2.0%. All studies recommended universal histopathologic evaluation of breast specimens.

[CONCLUSIONS] In this review, we found unanimous recommendations for performing histopathologic evaluation of breast reduction samples, consistent with the 2022 American Society of Plastic Surgeons clinical practice guideline. Further research is still required to determine the optimal preoperative imaging approach for breast reduction.