Oncologic Imaging in Patients Undergoing Breast Reduction.

Supplemental Digital Content is available in the text.

Sir:

Healthcare and cancer organizations in the United States have not published specific recommendations for mammography screening in patients undergoing breast reduction.[1] Because of the considerable variability in the proposed protocols for oncologic imaging in patients undergoing breast reduction, the authors of this article seek to determine the most commonly followed practices throughout the United States and the world.

METHODS

A web-based survey consisting of 9 questions was sent to surgeons using the list server of the American Society of Plastic Surgeons (Table 1). Their responses were recorded, and statistical correlations were investigated.

Table 1.

Survey Questions

RESULTS

The survey was sent to 7,836 members, whereas it returned “undeliverable” for 1,201 members. Six hundred seventy-four responses were obtained (response rate, 10.1%).

Ninety-three percent state that they routinely perform a breast examination preoperatively. Sixty-two percent state that they routinely request preoperative radiography screening, and of those, 93% request mammography. Of note, 46% do not follow a postoperative protocol for mammography screening (Supplemental Digital Content 1, which displays survey results in graph format, http://links.lww.com/PRSGO/A228).

Providers who perform more breast reductions are more likely to be aware of current screening guidelines (P = 0.0064). The shorter time a provider has been in practice, the more aware they are of current screening guidelines (P = 0.01), and the longer a provider has been in practice, the more likely they are to follow a postoperative protocol for screening (P = 0.0252). Also, if the provider works in a private practice setting, he/she is more likely to routinely request preoperative radiography screening than if in an academic setting (P = 0.0341).

DISCUSSION

Breast reduction can leave changes in the breast that may have oncologic significance although there is conflicting evidence on this matter. Proponents of increased perioperative imaging would argue that the changes within the breast could simulate the mammographic findings of carcinoma.[2,3] Those who would argue against increased imaging cite research performed by radiologists that has characterized mammographic findings after reduction mammoplasty and found that postoperative changes are predictable and distinguishable from neoplasms.[4]

Our study confirms the highly variable screening protocols demonstrated by providers performing breast reduction. Of those surveyed, 45.7% of responders do not follow a postoperative protocol for mammography screening. These providers likely hold to the belief that postoperative changes seen on radiography can be readily differentiated from carcinoma, supported by some of the previously mentioned literature.

Nearly 5% of respondents do not send tissue to pathology for analysis. There are numerous reports and studies that demonstrate the possibility of finding breast cancer in specimens sent during breast reduction.[5] By not sending tissue for pathologic analysis, the provider may be putting the patient at risk for undetected carcinoma. Although this risk is low, the potential cost of missing a lesion is high.

CONCLUSIONS

Our study evaluates the oncologic screening practices in plastic surgeons performing breast reduction. This study demonstrates the considerable variability in screening protocols and demonstrates the need for standardization of these practice parameters