What we should know in mammography after reduction mammoplasty and mastopexy?

Reduction mammoplasty and mastopexy (breast lift surgery) are becoming increasingly common procedures. Knowledge of characteristic mammographic findings and imaging findings of breast cancer are important to interpret mammography in this population.

Patients undergoing a mammography examination between March 2006 and March 2012 were consecutively included. Seventy mammography examinations in 39 patients after reduction mammoplasty and 22 mammography examinations in 19 patients after mastopexy were reviewed and analyzed retrospectively. We compared the frequency of each characteristic mammographic finding between reduction mammoplasty and mastopexy. We also analyzed imaging findings of breast cancer in this population.

The most frequent mammographic finding of the reduction mammoplasty was nipple elevation (84.3 %). Other findings included retraction of the lower breast (80 %), thickening of the skin (78.6 %), downward shifting of the glandular tissue (47.1 %), retroareolar fibrotic band (42.9 %), and areolar skin calcification or lipid cyst (35.7 %). The most frequent mammographic finding of mastopexy was thickening of the skin (72.7 %). Other mastopexy findings included elevation of nipple (68.2 %), areolar skin calcification or lipid cyst (36.4 %), retraction of lower position (31.8 %), and retroareolar fibrotic band (31.8 %). Downward shifting of glandular tissue and retraction of the lower portion have statistically lower frequency in mastopexy cases (P < 0.05). Two breast cancers were diagnosed in reduction mammoplasty cases. One was missed and one was detected but difficult to diagnose using mammography.

Although mammography alone is not sufficient for breast screening after reduction mammoplasty, it may be possible to use mammography for postoperative follow-up after mastopexy only. So, operators should recognize that after reduction mammoplasty it will be hard to detect early breast cancer.