Mammography and reduction mammaplasty

Background: Anecdotal descriptions of the discovery of occult breast cancers in reduction mammaplasty patients during the perioperative period have appeared in the literature. Subsequently, recommendations for routine preoperative and postoperative mammographic screening for reduction mammaplasty patients have been published. Other authors have recommended that only patients at risk according to the American Cancer Society's guidelines should have mammographic screening. Objective: The purpose of this study was to resolve some of the conflicting conclusions presented in the literature. Methods: Twenty reduction mammaplasty patients underwent preoperative and postoperative mammography. The mammograms were randomly mixed and evaluated in a blind study by 2 radiologists, who were asked to identify and describe any mammographic abnormalities, indicate which films were preoperative and which were postoperative, and make recommendations for the patient represented in each film. Results: N one of the mammograms identified as preoperative by the radiologists demonstrated any confirmed breast malignancies. Both radiologists reported some abnormalities among the preoperative views and identified a number of characteristic postoperative radiologic changes. Recommendations for patients represented in the films included additional views, repeat interval films, and biopsy. One radiologist accurately identified preoperative and postoperative mammograms in 72% of the films and the other radiologist in 54% of the films, with an overall agreement between the radiologists of only 50%. Conclusions: The radiologists' evaluations led the authors to recommend against routine preoperative mammography in all breast reduction patients; those breast reduction patients falling within American Cancer Society guidelines for mammographic screening because of high risk characteristics should undergo preoperative mammograms. Based on this study, the authors' recommendations include the option of performing postoperative baseline and interval mammography on all breast reduction patients and the alternative approach of carrying out postoperative baseline mammography only on high-risk patients-ie, those for whom routine screening would be recommended anyway or those whose excised breast tissue has demonstrated risk-indicating histologic features.