title: Should we routinely analyze reduction mammaplasty specimens?
abstract: BACKGROUND
  Reduction mammaplasty is one of the most common plastic surgery procedures. Preoperative imaging and histopathology protocols vary among countries and institutions. We aimed to analyze the incidence of occult breast cancer and high-risk lesions in reduction mammaplasty specimens. We also analyzed whether patients with abnormal histopathology differed from the study population in terms of demographics.
  
  
  METHODS
  In total, 918 women who underwent reduction mammaplasty from January 2007 to December 2011 were retrospectively reviewed for demographics, preoperative imaging, further preoperative examinations, pathology reports, and postoperative follow-up.
  
  
  RESULTS
  Abnormal histopathological findings were revealed in 88 (10%) patients with a mean age of 49.5 ± 10.2 years. The incidence of breast cancer was 1.2%, and the incidence of high-risk lesions (atypical ductal and lobular hyperplasia and lobular carcinoma in situ) was 5.5%. Age and specimen weights were significantly higher in patients with abnormal histopathology. Eighty-one percent of patients with abnormal histopathology had normal preoperative imaging revealing two high-risk and two cancer findings. Two patients developed breast cancer in the same breast in which the high-risk lesion was originally detected.
  
  
  CONCLUSIONS
  Women with abnormal histopathology cannot be sufficiently detected preoperatively. Therefore, histopathological analysis of reduction mammaplasty specimens seems mandatory. Reduction mammaplasty combined with subsequent histopathological examination offers a sufficient chance of detecting cancer and risk-increasing lesions that merits the cost of histopathology.
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 266, 00029 HUS, Finland. Electronic address: paivi.merkkola-vonschantz@hus.fi.
authors.forename: Päivi A
authors.initials: PA
authors.lastname: Merkkola-von Schantz
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 266, 00029 HUS, Finland.
authors.forename: Tiina A
authors.initials: TA
authors.lastname: Jahkola
authors.affiliation: Department of Pathology, University of Helsinki and Helsinki University Hospital, P.O. Box 800, 00029 HUS, Finland.
authors.forename: Leena A
authors.initials: LA
authors.lastname: Krogerus
authors.affiliation: Department of Radiology, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029 HUS, Finland.
authors.forename: Katja S
authors.initials: KS
authors.lastname: Hukkinen
authors.affiliation: Department of Plastic and Reconstructive Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 266, 00029 HUS, Finland.
authors.forename: Susanna Mc
authors.initials: SM
authors.lastname: Kauhanen
mesh_terms: D000328:Adult; D001940:Breast / Q000473:pathology* / Q000601:surgery; D001941:Breast Diseases / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033162:Incidental Findings; D016462:Mammaplasty / Q000379:methods*; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Benign breast disease; Breast Imaging; Cancer; High-risk lesion; Reduction mammaplasty