Bilateral reduction mammoplasty following breast cancer: A case-control study

Abstract

S ymptoms of breast hypertrophy can affect post-treatment breast cancer patients. The true incidence of breast hypertrophy in the breast cancer population is unknown, as is the number of such patients seeking reduction mammoplasty surgery following breast cancer treatment. These patients have usually undergone lumpectomies followed by postoperative radiation therapy and chemotherapy. Although there can be changes in the shape and size of the treated breast as a result of lumpectomy and radiation, it is usually minimal in nature, resulting in, at most, asymmetry (1,2). In the macromastic patient, symptoms of interscapular back pain, prominent shoulder grooving, and intertrigo along the inframammary folds or between the breasts remain despite the described changes to the cancer-afflicted breast.Numerous publications regarding breast reconstruction following irradiation report that the radiated breast site is more prone to complications than the nonradiated breast (2-5). Currently, little information has been published regarding reduction mammoplasties performed on women previously treated for breast cancer. The radiated breast is expected to exhibit a likelihood of delayed wound healing, increased postoperative complications and less pleasing final results. In addition, it is unclear whether reduction mammoplasty in the radiated breast can be safely performed without interfering with mammography and cancer surveillance. We sought to review the outcomes of patients who underwent bilateral reduction mammoplasty following lumpectomy and radiation for breast cancer. The primary focus of the present study was the subsequent complications and need for additional surgery in this (particular?) patient population. MethodsAfter approval from the Hamilton Health Sciences Research Ethics Board, a retrospective search was conducted using the health records of Hamilton Health Sciences, McMaster University and the Juravinski Cancer Centre (Hamilton, Ontario) to identify patients who underwent lumpectomy and radiation (with or without chemotherapy) for breast cancer with subsequent bilateral reduction mammoplasty between 1980 and 2007. Patients who had undergone bilateral or unilateral reduction mammoplasty surgery before lumpectomy and radiation treatment, breast augmentation or lumpectomy alone were excluded from the study. PurPose: Many women undergo a bilateral reduction mammoplasty after lumpectomy and radiation for breast cancer due to breast hypertrophy. The outcomes of these patients, focusing on complications and the need for additional surgery, are reviewed. Methods: A matched case-control study with patients serving as their own control (treated breast cancer breasts were 'cases', healthy breasts were 'controls') was performed. Patients were identified through hospital records between 1980 and 2007. Patients treated by lumpectomy and radiation with subsequent bilateral reduction surgery were included. Data regarding demographics, medical history, and peri-and postoperative complications were collected. Measured outcome...

Natural course of fat necrosis after breast reconstruction: a 10-year follow-up study

“…Several risk factors associated with the occurrence of fat necrosis after surgery have been proposed, which include neoadjuvant chemotherapy, adjuvant radiotherapy, high BMI, and uncontrolled underlying disease [37][38][39][40]. However, there was no significant factor associated with fat necrosis in our study.…”

Risk Factors for Complications after Reduction Mammoplasty: A Meta-Analysis

“…The overall incidence of complications of 11 studies [6, 11, 14, 15, 17, 18, 20–24] was 11.0% (ranged 5% to 56%), while the rest [5, 19, 25–27] reported only some specific complications, lacking the total quantities. Various operative techniques were used, in which the most frequent technique was the inferior pedicle with an average percentage of 46.0%.…”

“…We finally selected 3 studies [25–27] reporting radiation therapy and complications after RM. The test for heterogeneity was not significant (p for heterogeneity = 0.46; I 2 = 0%).…”

“…Several investigators had reported significantly increased rates of complications in patients treated with radiation, and some, including Dal Cin A et al[25] and Parrett BM et al[26], considered radiation therapy a contraindication to RM. We presumed that it was due to the known harmful effects of radiation.…”

Breast Reduction in Patients with Prior Breast Irradiation

“…Recent studies have reported acceptable complication rates in small series of patients with a history of breast irradiation and subsequent treatment with reduction mammaplasty. [13][14][15][16][17][18] However, these reports have used traditional approaches to breast reductions using the inferior pedicle technique and, although the results were acceptable overall, a few patients suffered from major complications necessitating the use of a latissimus flap for salvage. In the current report, we present our experience with a less invasive approach using the central mound technique to preserve skin and glandular blood supply and enabling us to perform reduction mammaplasty with improved symmetry.…”