Breast reduction remains as a very popular and commonly performed plastic surgery procedure. It provides a dual reconstructive and cosmetic benefit by making the large breast better shaped and more uplifted and improves back, shoulder and neck pain by breast volume reduction. As part of the breast reduction procedure, segments of breast tissue are removed and almost always sent to pathology for examination. While I have yet in my Indianapolis plastic surgery practice to have positive cancer findings from submitted breast reduction tissues, prior published and anectodal reports confirm that it does occur.
The finding of breast cancer during a reduction procedure can occur in two circumstances. The first is during the course of the operation some suspicious tissue is found and sent to pathology for an immediate evaluation, known as a frozen section. The second is when the submitted tissues are examined by the pathologist and cancerous tissue is found. In a November 2009 issue of the journal Plastic and Reconstructive Surgery, a published paper looked exactly at this second issue. From 202 breast reduction patients, the incidence of significant pathologic findings (cancer or atypical hyperplasia) was present in 12.4% of the patients. This translates into a rate of 4% of all patients with no real difference when the age of the patient is taken into consideration. (6% under age 40, 8% above age 40)
This is a rather surprising finding given that prior published reports do not have near this high an incidence of abnormal findings in breast reduction. I suspect this is a function of specifically looking for it as this report had both gross and microscopic examinations done in some detail. However, given the general incidence of breast cancer in women, it does seem logical that a significant number of yet symptomatic women have the disease.
This raises an interesting question that I have always had. Does breast reduction surgery decrease the incidence of breast cancer? Will it decrease the risk of some women from eventually getting breast cancer? The answer to that is an emphatic yes….for some but not all women.
In 2004, a study published in the June issue of Plastic and Reconstructive Surgery reported a difference in risk of breast cancer after breast reduction surgery. This appears to be especially true in women who are over 40 years old at the time of surgery. Risk of cancer reduction in this age group was 28 to 50 percent. No reduction was seen in women having the surgery before the age of 40. Although the complete removal of a woman’s breasts (prophylactic mastectomy) can virtually eliminate the risk of breast cancer, most women find it extremely difficult to elect to remove all of their breast tissue. Women now have an additional preventative option to have their breasts partially reduced rather than removed. This represents a real alternative for someone who is a candidate for breast reduction, even though the amount of tissue removed may be small.
Given the occult incidence of breast cancer found is the pathology of asymptomatic breasts during routinue breast reduction surgery, this can be viewed as an additional benefit of the operation. However, I would emphasize that breast reduction is a risk reducer, not a preventative guarantee
Dr. Barry Eppley
Indianapolis, Indiana