The recent 2020 issue of Plastic and Reconstructive Surgery Journal had an article on breast reductions in breast cancer patients. “Occult Breast Carcinoma is More Common in Women Undergoing Breast Reduction after Contralateral Cancer: A Systematic Review and Meta-Analysis.” In English, this means we find a hidden breast cancer in the breast tissue removed by doing a breast reduction in women with a breast cancer in the other breast.
When we do breast cancer surgery, it is common to operate on the non-cancer side as well. We operate on the non-cancer breast to create symmetry with the reconstructed breast, and insurance covers the cost. For a natural larger, droopy breast, the symmetry surgery is frequently a breast reduction and breast lift. When we do a breast reduction, we always send the breast tissue to pathology for analysis. The question posed by this journal article is how often do they find cancer in the breast reduction tissue?
Of note, this is doing a breast reduction in a patient who has known cancer in the other breast. We know if you have had breast cancer, you are at higher risk for another cancer. So this is not earth shattering to hear, and you need to remember these breast reductions are not your run of the mill breast reduction. Already we know these patients are at higher risk.
Study:
- Meta-analysis of 42 studies, 29 had quantitative data.
- For those women who had a history of breast cancer, 3.4% found occult cancers in the breast reduction specimen, VS 0.6% for women with no history of breast cancer
So?
The authors show this statistically significant difference, and urge for a need for preoperative screening, counseling, and guidelines to advise these women.
My thoughts?
All my patients have to have a recent (ideally within 6 month) evaluation of both breasts prior to a breast reduction. That is so we can find these things out ahead of time, and not be surprised by a hidden cancer in the breast reduction pathology specimen. I do many breast reductions every year, and once every 5 – 10 years I have to cancel a breast reduction because their screening mammogram or MRI found a cancer. In these cases, I do not do a breast reduction. They have a mastectomy or lumpectomy to remove the cancer.
Even with screening though we may not find the cancer ahead of time. Not all cancers though are visible by mammogram, ultrasound, or MRI. For this reason we always send the breast tissue to pathology for analysis.
This study shows a hidden cancer was six times higher in women with a history of breast cancer than in non-breast cancer patients. It is a good reminder to have the discussion and be vigilant about pre surgical testing.