Atypical Proliferative Lesions after Reduction Mammaplasty: Incidence and Implications in 993 Reductions
Amy S. Colwell, MD, Melissa Mastroianni, M.D., Alex Lin, M.S., William G. Austen, Jr., M.D..
Massachusetts General Hospital, Boston, MA, USA.
PURPOSE: Reduction mammoplasty occasionally reveals unsuspected proliferative lesions or carcinoma. Few studies examine incidence, risk factors, and outcomes in this population. METHODS: Retrospective review was performed between 2000 and 2012. Pathology was categorized as benign, proliferative, or cancer (DCIS or invasive). RESULTS: Five hundred seventy-three patients had 993 reduction mammaplasties (85% bilateral, 15% unilateral). Cancer was detected in 23 (2.3%) specimens and proliferative lesions in 148 (14.9%). Compared to patients with benign pathology, patients with proliferative lesions or cancer were older (p<0.001), with larger BMI (p=0.001), increased unilateral procedures (p<0.001) and more had a history of cancer (p<0.001) (Table 1). On multivariate regression analysis, age and prior breast cancer were independent risk factors for proliferative lesions (OR 1.057, CI 1.039-1.075, p<0.001 and OR 2.201, CI 1.291-3.752, p=0.004) and age significantly predicted cancer (OR 1.050, CI 1.009-1.093, p=0.015). There was no association with resection weight (p>0.5). Fifty-four percent of patients with proliferative lesions and no history of cancer had a change in management with increased surveillance, hormones, radiation, chemotherapy, or surgery. If there was a history of cancer, 31% had a change in management. Of patients with DCIS or cancer, all required treatment. CONCLUSIONS: Proliferative lesions of the breast may be more common that previously reported. Age and a history of breast cancer increase risk for proliferative lesions. All should be referred to oncology.
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