"Reductive" Reasoning: Identifying Normal Postoperative Changes Versus Malignancy After Reduction Mammoplasty

Given the increasing frequency of reduction mammoplasty (RM) procedures, it is essential for radiologists to develop expertise in the accurate evaluation and interpretation of postoperative breast imaging findings. This pictorial essay reviews common RM surgical techniques with the resultant expected imaging findings on mammography, ultrasound, and MRI. Findings include symmetric parenchymal redistribution, architectural distortion and scar tissue, benign calcifications, and fat necrosis. Recognizing these patterns is essential to avoid misinterpreting benign postoperative changes as malignancy as well as to identify suspicious findings that require further evaluation. Diagnostic challenges include differentiating post-surgical scarring from malignancy, especially in the lower half of the breast. Cases of breast malignancy after RM are presented to highlight important differentiation between expected postoperative changes and breast cancer.