Breast cancer remains a threat to every women and the emphasis on early detection can not be overemphasized. As October and Breast Cancer Awareness Month has now passed, the upcoming holiday season may temporarily displace some of these concerns. Plastic surgery throughout the year, however, plays an inadvertent but beneficial role in the detection and management of this disease.
Breast reduction remains as a very popular and commonly performed plastic surgery procedure. It provides a dual reconstructive and cosmetic benefit by making the large breast better shaped and more uplifted and improving back, shoulder and neck pain by size reduction. As part of the reduction procedure, breast tissue removed is almost always sent to the Pathologist for examination. While I have yet to have positive cancer findings from submitted breast reduction tissues, reports exist that it is occasionally found.
The finding of breast cancer during a reduction procedure can occur in two circumstances. The first is during the course of the operation some suspicious tissue is found and sent to pathology for an immediate evaluation, known as a frozen section. The second is when the submitted tissues are examined by the pathologist and cancerous tissue is found. A recent study report has shown that the finding of breast cancer or precancerous tissue in pathology specimens existed in 12% of the patients studied in one treatment center.
This is a rather surprising finding given that prior published reports have not shown such high caner rates of cancer detection in breast reduction patients. However, given the relatively high incidence of breast cancer in women, it does seem logical that a significant number of yet symptomatic women have the disease.
This raises an interesting and obvious question. Does breast reduction surgery decrease the incidence of breast cancer? Will it decrease the risk of some women from eventually getting this disease? The answer to that is an emphatic yes….for some but not all women.
This question has been looked at and reported on in 2004. A study published in the pretigous journal of Plastic and Reconstructive Surgery reported a difference in risk of breast cancer after breast reduction surgery. This appears to be especially true in women who are over 40 years old at the time of surgery. Risk of cancer reduction in this age group was 28 to 50 percent. No reduction was seen in women having the surgery before the age of 40. Although the complete removal of a woman’s breasts (prophylactic mastectomy) can virtually eliminate the risk of breast cancer, most women find it extremely difficult to elect to remove all of their breast tissue. Women now have an additional preventative option to have their breasts partially reduced rather than removed. This represents a real alternative for someone who is a candidate for breast reduction, even though the amount of tissue removed may be small.
Given the occult incidence of breast cancer found in the pathology of asymptomatic women during routinue breast reduction surgery, this can be viewed as an additional benefit of the operation. However, I would emphasize that breast reduction is a risk reducer, not a preventative guarantee.
Dr. Barry Eppley