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Routine Pathology Examination of Breast Tissue in Adolescent Reduction Mammaplasty: Not Cost Effective in a 7-Year
H Harvak Hajebian, Salomon Puyana1, Natalia Mejia2
1Division of Plastic Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA.
Annals of Plastic Surgery
|March 28, 2023
Summary
Routine pathology examination of breast tissue in adolescent reduction mammaplasty (RM) is not cost-effective, as no incidental malignancies were found. This study suggests focusing on evidence-based healthcare spending and reducing strain on pathology services.
Area of Science:
- Plastic Surgery
- Oncology
- Health Economics
Background:
- Routine pathology examination of breast tissue during reduction mammaplasty (RM) aims to detect incidental malignancies or risk-increasing lesions.
- In adolescent patients, the reported incidence of such findings is extremely low (0% to 0.01%), with significant costs associated with pathology claims ($23-$614 per analysis).
Purpose of the Study:
- To investigate the rate of incidental findings in adolescent RM patients.
- To assess the cost-effectiveness of routine pathology examination in this demographic.
Main Methods:
- A single-center retrospective review of 132 breast specimens from 66 consecutive adolescent RM patients (ages 10-24).
- Data collected included breast cancer risk factors, demographics, and operative variables.
Main Results:
- No incidental malignant or risk-increasing lesions were identified in any of the 132 specimens.
- Benign fibrocystic disease was found in 26% of specimens, associated with BMI > 30 kg/m² and tissue resection weight > 1000 g per breast.
Conclusions:
- Routine specimen analysis in adolescent RM is not cost-effective, with an estimated cost exceeding $150 million for one breast cancer diagnosis in this age group.
- The findings support existing literature indicating no occurrence of incidental findings in young women undergoing RM.
- This study advocates for evidence-based healthcare spending and reducing the burden on histopathology services.
