[The familial carcinoma burden and indications for subcutaneous mastectomy]

Histological examination of the surgical specimen was undertaken in 182 women (aged between 20 and 58 years, mean 44 years) after a subcutaneous mastectomy, which had been performed largely because the diagnosis of the breast lesion had been problematic. Among 46 patients, operated on exclusively because of either palpatory or radiological diagnostic problems, histological examination revealed occult carcinoma or precancerous lesion in two, while among 58 patients with combined palpatory and radiological diagnostic problems there were twelve with invasive or noninvasive carcinoma, and among seven with at least four preoperative biopsies there was none. Four of 41 patients who had previously had a modified radical mastectomy of the other breast for invasive breast cancer had invasive or noninvasive carcinoma, as well as 18 of 30 patients with biopsy-confirmed proliferative breast lesion. There was a statistically significant correlation between the incidence of occult carcinoma and familial incidence. The results indicate that subcutaneous mastectomy is justified in case of diagnostic problems only if (1) in the presence of an increased genetic risk neither palpatory nor radiological diagnosis is clearcut, (2) there is known contralateral carcinoma, or (3) preoperative examination demonstrates proliferative lesions with atypical epithelium.