The Management of Breast Cancer Detected by Reduction Mammaplasty




The incidence of occult breast cancer detected by reduction mammoplasty is 0.06% to 5.45%. Preoperative screening mammography is indicated in all women 40 years and older and in women age 35 with a positive family or personal history of breast cancer before reduction mammoplasty. Breast MRI is considered in women with dense breasts and those with hereditary breast cancer syndromes. Management of occult breast cancer is impacted by specimens being typically removed in pieces and not oriented before submission to pathology. Total mastectomy is the most common treatment because of the uncertainties regarding margin status and disease extent.


Key points







  • •

    Occult breast cancer detected by reduction mammaplasty is 0.06% to 5.45%; The incidence is higher in older women and if the reduction is performed as a symmetry procedure for contralateral breast cancer.


  • •

    Preoperative screening mammography is indicated in all women 40 years and older and in women age 35 with a positive family or personal history before reduction mammaplasty.


  • •

    Two-thirds of cases found at the time of reduction mammaplasty are noninvasive and the majority are mammographically occult.


  • •

    Management of occult cancer is impacted by specimens being removed in pieces and not oriented before submission to pathology. Total mastectomy is common because of uncertainties regarding margin status and disease extent.






Introduction


Reduction mammaplasty is one of the most commonly performed plastic surgery procedures. The American Society of Plastic Surgeons estimates 110,000 women in the United States underwent reduction mammaplasty for symptomatic macromastia or for symmetry in 2014. The incidence of occult cancer detected after breast reduction mammaplasties is very low, ranging from 0.06% to 5.45% ( Table 1 ). The incidence is higher in older women and if the reduction is performed as a symmetry procedure for a patient with a history of contralateral cancer. Tang and colleagues used the Ontario Cancer Registry to examine the incidence of invasive breast cancer found at the time of bilateral breast reduction. A total of 27,500 women were studied, 17 (0.06%) were found to have invasive breast cancer. The mean age of women with breast cancer found at the time of breast reduction was 49 years. In comparison, the overall mean age of women in the general population diagnosed with breast cancer was 61 years. Cancers found in the reduction mammaplasty patients were at an earlier stage and had a better survival than the control group.



Table 1

Incidental breast cancer detected after reduction mammaplasty


































































































































Study, Year Patients (n) Mean Age (y) History of Breast Cancer Incidence (per patient) % Overall Carcinoma (per patient)
Jansen et al, 1998 2576 NS No 4 (0.16) 0.16
Tang et al, 1999 27,500 49 No 17 (0.06) b 0.06
Ishag et al, 2003 518 NS No IC: 2 (0.39)
DCIS: 1 (0.19) 		0.58
Ishag et al, 2003 42 NS Yes IC: 1 (2.4) 2.38
Colwell et al, 2004 611 38 No IC: 2 (0.3)
DCIS: 2 (0.3) 		0.07
Colwell et al, 2004 170 61 Yes IC: 1 (0.6)
DCIS 1 (0.6) 		1.18
Cook et al, 2004 1289 36.8 — IC: 1 (0.1)
DCIS: 4 (0.3) 		0.31
Dotto et al, 2008 516 35 No IC: 1 (0.19)
DCIS: 1 (0.19) 		0.39
Ambaye et al, , c 2009 181 NS No IC: 2 (1.1)
DCIS: 3 (1.7) 		2.76
Clark et al, 2009 562 a NS DCIS: 6 (1.1) 1.1
Slezak et al, 2011 629 NS No IC: 3
DCIS: 6 		0.95
Hassan et al, 2012 1061 37 No IC: 1 (0.09)
DCIS: 4 (0.38) 		0.05
Hassan et al, 2012 220 52 Yes IC: 3 (1.36)
DCIS: 1 (0.45) 		1.82
Desouki et al, 2013 2498 41 No IC: 2 (0.08)
DCIS: 4 (0.16) 		0.24
Tadler et al, 2014 479 NS No DCIS: 2 (0.42) 0.42
Tadler et al, 2014 55 NS Yes DCIS: 3 (5.45) 5.45
Sorin et al, 2015 2718 54.0 Yes IC: 12 (0.44)
DCIS: 28 (1.03) 		1.47

Abbreviations: DCIS, ductal carcinoma in situ; IC, invasive cancer; NS, not stated.

a Patients with history of breast cancer mean age 52, patients without history of breast cancer mean age 42.


b Invasive cancer only.


c Increased pathologic sampling.





Introduction


Reduction mammaplasty is one of the most commonly performed plastic surgery procedures. The American Society of Plastic Surgeons estimates 110,000 women in the United States underwent reduction mammaplasty for symptomatic macromastia or for symmetry in 2014. The incidence of occult cancer detected after breast reduction mammaplasties is very low, ranging from 0.06% to 5.45% ( Table 1 ). The incidence is higher in older women and if the reduction is performed as a symmetry procedure for a patient with a history of contralateral cancer. Tang and colleagues used the Ontario Cancer Registry to examine the incidence of invasive breast cancer found at the time of bilateral breast reduction. A total of 27,500 women were studied, 17 (0.06%) were found to have invasive breast cancer. The mean age of women with breast cancer found at the time of breast reduction was 49 years. In comparison, the overall mean age of women in the general population diagnosed with breast cancer was 61 years. Cancers found in the reduction mammaplasty patients were at an earlier stage and had a better survival than the control group.



Table 1

Incidental breast cancer detected after reduction mammaplasty


































































































































Study, Year Patients (n) Mean Age (y) History of Breast Cancer Incidence (per patient) % Overall Carcinoma (per patient)
Jansen et al, 1998 2576 NS No 4 (0.16) 0.16
Tang et al, 1999 27,500 49 No 17 (0.06) b 0.06
Ishag et al, 2003 518 NS No IC: 2 (0.39)
DCIS: 1 (0.19) 		0.58
Ishag et al, 2003 42 NS Yes IC: 1 (2.4) 2.38
Colwell et al, 2004 611 38 No IC: 2 (0.3)
DCIS: 2 (0.3) 		0.07
Colwell et al, 2004 170 61 Yes IC: 1 (0.6)
DCIS 1 (0.6) 		1.18
Cook et al, 2004 1289 36.8 — IC: 1 (0.1)
DCIS: 4 (0.3) 		0.31
Dotto et al, 2008 516 35 No IC: 1 (0.19)
DCIS: 1 (0.19) 		0.39
Ambaye et al, , c 2009 181 NS No IC: 2 (1.1)
DCIS: 3 (1.7) 		2.76
Clark et al, 2009 562 a NS DCIS: 6 (1.1) 1.1
Slezak et al, 2011 629 NS No IC: 3
DCIS: 6 		0.95
Hassan et al, 2012 1061 37 No IC: 1 (0.09)
DCIS: 4 (0.38) 		0.05
Hassan et al, 2012 220 52 Yes IC: 3 (1.36)
DCIS: 1 (0.45) 		1.82
Desouki et al, 2013 2498 41 No IC: 2 (0.08)
DCIS: 4 (0.16) 		0.24
Tadler et al, 2014 479 NS No DCIS: 2 (0.42) 0.42
Tadler et al, 2014 55 NS Yes DCIS: 3 (5.45) 5.45
Sorin et al, 2015 2718 54.0 Yes IC: 12 (0.44)
DCIS: 28 (1.03) 		1.47

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Nov 17, 2017 | Posted by in General Surgery | Comments Off on The Management of Breast Cancer Detected by Reduction Mammaplasty

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