by Mastroianni,
Melissa; Lin, Alex; Hughes, Kevin; Colwell, Amy S.
Background:
Reduction mammaplasty relieves symptomatic macromastia. Pathologic specimens
occasionally reveal unsuspected proliferative lesions or carcinoma. Few studies
examine the incidence, risk factors, and outcomes in this population.
Methods: A
retrospective review was performed between 2000 and 2012. The pathologic
condition was categorized as benign, proliferative, or cancer.
Results: Five hundred seventy-two patients underwent 995
reduction mammaplasties. Cancer was detected in 23 specimens (2.3 percent) and
proliferative lesions were detected in 137 (13.8 percent). Compared with
patients with benign pathologic findings, patients with proliferative lesions
or cancer were older (p < 0.001), had greater body mass index (p = 0.003),
had increased unilateral procedures (p < 0.001), and more had history of
cancer (p < 0.001). On multivariable regression analysis, age (OR, 1.058; 95
percent CI, 1.040 to 1.077; p < 0.001) and prior breast cancer (OR, 2.070;
95 percent CI, 1.328 to 3.227, p = 0.001) were independent risk factors for
proliferative lesions, and age significantly predicted cancer (OR, 1.054; 95
percent CI, 1.012 to 1.097; p = 0.010). Forty-one percent of patients with
proliferative lesions and no history of cancer had a change in management. If there
was a history of cancer, 54 percent had a change in management.
Conclusions:
Proliferative lesions of the breast may be more common than previously
reported. Age and a history of breast cancer increase the risk for
proliferative lesions. All should be referred to oncology, as nearly half of
these patients will have a change in management. CLINICAL QUESTION/LEVEL OF
EVIDENCE: Risk, III.
