The role of reduction mammaplasty in oncology

Background: A procedure to achieve symmetry is required in almost 50% of the cases of breast reconstruction and provides an opportunity to explore the second breast and eventually to remove any area which is suspect. The various techniques available for the symmetry procedure should be discussed according to the breast exploration required. This study analyzes the different types of reduction mammaplasty (RM) techniques, the histology and localization of contralateral tumors which allow the plastic surgeon to diagnose occult breast cancer more accurately.Method: From 1978 to 1993, 1814 patients with breast cancer underwent a mastectomy with breast reconstruction at the Gustave-Roussy Institute. A contralateral RM to achieve symmetry was performed in 440 patients.Results: Twenty (4.5%) clinically and radiologically occult breast cancers were found among the contralateral RM specimens. The relationship between the type of RM technique and incidence of occult breast cancer was not significant: 16 cases of occult breast carcinomas in 305 RM with supra-areolar pedicle and four cases from 135 RM with infra-areolar pedicle (Fisher exactp=0.21).Conclusion: Close collaboration between plastic surgeon and oncologist is required while performing a breast reconstruction in order to take advantage of the surgery of the second breast to explore the gland and to remove occult carcinomas in approximately 5% of cases. The choice of RM procedure depends usually on the shape of the breast and often the personal preference of the surgeon but this should also be planned according to the glandular area to be explored. There results underline the absolute necessity of histological examination of all the specimens removed in all kinds of breast reduction also when it is performed for purely aesthetic reasons.