Discussion of preoperative mammography in women undergoing reduction mammaplasty

Reduction mammaplasty is one of the most common procedures performed by plastic surgeons. Previous studies demonstrated that most plastic surgeons do not require preoperative mammography prior to reduction mammaplasty. The incidental discovery of malignant or high-risk lesions in breast reduction specimens may preclude the possibility of breast-conserving surgery. The purpose of this study was to examine the factors associated with discussion of preoperative mammography with reduction mammaplasty patients.

About 638 consecutive patients were identified between January 2000 and December 2010 who underwent reduction mammaplasty. Clinicopathologic and treatment information was collected. Factors associated with discussion of preoperative mammography prior to surgery were compared.

Of 638 patients, the median age was 36 (range 18-77) with 44% ≥40. Approximately half (56.0%) were White and 37.5% were African-American. The use of mammography was discussed in 43.3% of patients and completed in 41.5%. On final pathology, eight patients (1.3%) had high-risk lesions and two (0.3%) demonstrated malignancy (1 DCIS, 1 invasive). Of these 10 patients, two were under the age of 40 and four had preoperative mammograms. Factors associated with mammography discussion were age ≥40, White race, the presence of comorbidities, family history of breast cancer, prior breast surgery, prior breast biopsy, history of breast cancer (all P < 0.0001) and tobacco use (P = 0.04).

Due to the potential risk of invasive cancer and high-risk lesions in the final surgical specimen, preoperative mammography should be discussed with selected patients by plastic surgeons, particularly those who fall within national screening guidelines.