Risk of breast cancer among reduction mammaplasty patients and the strategies used by plastic surgeons to detect such cancer.

BACKGROUND: Estimates of the occurrence of breast cancer among reduction mammaplasty patients vary from 0.05 to 1.66 percent, and the chance of finding such cancers is affected by the thoroughness of preoperative and postoperative examinations. The authors' aims were to make a more exact and age-specific estimation of this occurrence and to evaluate the strategies used by Netherlands plastic surgeons to detect these cancers.
METHODS: The annual number of reduction mammaplasty patients per 5-year age group and the annual age-specific incidence rate of breast cancer for the years 1992 through 2001 were obtained from two national registries. Using these, the authors estimated the expected number of breast cancers among reduction mammaplasty patients in each year. In 2002, the authors sent an anonymous questionnaire to 220 Dutch consultant and trainee plastic surgeons to evaluate their detection strategies.
RESULTS: The fraction of patients aged 50 years or older increased from 9.6 percent to 23 percent, and the estimated occurrence of breast cancer among patients increased from 0.05 percent to 0.11 percent. Responders to the questionnaire were inconsistent regarding their preoperative and postoperative detection strategies, with only 3 percent of them routinely requiring a preoperative mammogram and 75 percent of them routinely submitting the surgical specimen for histopathologic examination.
CONCLUSIONS: The occurrence of previously undetected breast cancer among reduction mammaplasty patients in The Netherlands is likely to increase further. The authors advocate preoperative mammography for all reduction mammaplasty patients aged 40 years or older and argue that a history and physical examination should be performed for all patients.