The Incidence of Malignant and High-Risk Pathology Findings in Postreduction Mammaplasty Patients

Introduction: Reduction mammaplasty is often performed to alleviate symptoms of macromastia or for symmetry after a lumpectomy in the contra-lateral breast. Abnormal pathology including breast cancer can be incidentally found in reduction mammaplasty specimens, but there is no consensus on risk factors or detection rates. This study aimed to elucidate the incidence of malignant and high-risk pathology findings in patients undergoing breast reduction in a Canadian context. Methods: We conducted a retrospective review of all reduction mammaplasty cases performed by 5 surgeons between January 2001 and May 2023. Patients were categorized into Group A, those undergoing bilateral reduction for macromastia symptoms, and Group B, those with a history of breast-conserving surgery seeking unilateral reduction postlumpectomy. Results: In total, 1383 breasts from 872 patients were examined: 1022 in Group A and 361 in Group B. Group B was significantly older (56.9 ± 9.3 vs 44.0 ± 13.9 years) whereas Group A had a significantly higher BMI (33.1 ± 8.4 vs 30.1 ± 5.8). High-risk and malignant pathology incidence was 1.4% overall. The sole malignancy detected was in a patient in Group A without prior breast cancer history. Multivariate analysis revealed BMI as a significant predictor for high-risk pathologies (OR 1.134, 95% CI [1.012-1.271]). Conclusions: Our findings align with previously reported incidence rates of pathological findings in mammaplasty specimens and highlight the correlation between BMI and pathology risk. These results underscore the importance of a comprehensive history and preoperative counselling about the possibility of further treatment following pathological discoveries during reduction mammaplasty.