A Risk-Stratified Comparison of High-Risk Findings in Reduction Mammoplasty.

[BACKGROUND] Reduction mammoplasty is indicated for symptomatic macromastia or breast asymmetry after contralateral cancer surgery. Previous studies compared the incidence of high-risk lesions in resection specimens between these 2 groups. However, no studies have compared incidental findings in breast reduction specimens based on relative risk of cancer. Our study stratifies lesions by relative risk of malignant progression and compares the frequency of these findings in bilateral versus unilateral reduction mammoplasties.

[METHODS] Charts were reviewed from 422 patients undergoing breast reductions by a single surgeon over a 10-year period. Age, procedure, specimen weight, and histologic findings were recorded. Pathologic data were stratified by relative risk of malignant progression and compared between patients with and without cancer histories.

[RESULTS] Three hundred five patients underwent bilateral reduction mammoplasty and 117 patients underwent unilateral reduction mammoplasty over the 10-year period. Bilateral patients had a higher incidence of benign lesions (P = 0.02). Both groups had similar incidences of proliferative lesions (P = 0.48). Unilateral patients had a higher incidence of atypia (P = 0.05) and carcinoma in situ (P < 0.01). One unilateral patient had an incidentally found invasive carcinoma.

[CONCLUSIONS] Patients undergoing unilateral reduction after oncologic resection have a higher incidence of high-risk lesions compared with those undergoing bilateral reductions for macromastia. Although others have compared incidental findings between these cohorts, no group has compared these incidental findings stratified by risk. Our data underscore the importance of pathologic analysis of reduction specimens for early detection of high-risk lesions and will prove valuable for preoperative counseling before reduction mammoplasty for either of these indications.