Hidden Findings: Why We Test Tissue After Breast Reduction
The Routine Lab Test
When you undergo a breast reduction, your surgeon removes excess fat, skin, and glandular tissue. But what happens to that tissue?
Most patients assume it is simply discarded. However, standard safety protocols require this tissue to be sent to a lab for evaluation. While the goal of surgery is relief from physical pain, this routine step can sometimes uncover “occult” (hidden) medical findings.
The Evidence: The ASPS Recommendation
The American Society of Plastic Surgeons (ASPS) provides clear “Gold Standard” guidelines for this procedure.
- The Rule: Plastic surgeons should send breast tissue from all patients for pathologic evaluation.
- The Benefit: This allows for the early detection of cancer or high-risk lesions.
- The Rationale: Preoperative mammograms are helpful but not perfect. They do not always catch the tiny abnormalities found in surgical specimens.
What the Research Says: The Emory University Study
A major study from Emory University analyzed the records of 1,014 patients who had breast reductions over 20 years. The researchers wanted to know how often hidden (occult) cancer or high-risk cells were found.
They split the patients into two groups:
- Group A: Women with no history of breast cancer.
- Group B: Women who had a previous breast cancer diagnosis.
The Incidence of Hidden Findings
The study found that these hidden findings are “not uncommon”.
- For General Patients (Group A): High-risk or malignant cells were found in 1.8% of patients.
- For Cancer Survivors (Group B): The risk was much higher, 8% of these patients had hidden findings in their reduction specimens.
Who Is at Higher Risk?
The research identified two major “positive predictors” for finding hidden abnormalities during surgery:
- Increasing Age: As patients get older, the likelihood of a positive finding increases.
- Personal History: Having a previous breast cancer diagnosis is a significant risk factor.
Why This Matters for Your Safety
Finding these cells early is a major benefit. Identifying high-risk lesions allows your medical team to start early treatment or more frequent screening.
As the authors of the study concluded, it is crucial for surgeons to maintain open communication with the lab. This ensures that if something is found, your follow-up care is precise and effective.
Frequently Asked Questions (FAQ)
Q: If my mammogram was clear, do I still need a lab test?
A: Yes. Research shows that 81% of patients with abnormal findings in their surgery tissue had a “normal” preoperative mammogram. The lab test is a necessary safety net.
Q: Is it common to find cancer during a breast reduction?
A: No, it is rare. In general patients, the risk is about 1.8%. However, “high-risk” cells (which are not cancer but could lead to it) are found slightly more often.
Q: Does insurance cover the cost of the lab test?
A: Generally, because this is a standard-of-care recommendation from the ASPS, it is treated as a necessary part of the medical procedure.
References
- [1] Razavi, Seyed Amirhossein M.D.; et al. “The Incidence of Occult Malignant and High-Risk Pathologic Findings in Breast Reduction Specimens.” Plastic and Reconstructive Surgery 148(4):p 534e-539e, October 2021.
- [2] Perdikis, Galen M.D.; et al. “Evidence-Based Clinical Practice Guideline: Revision: Reduction Mammaplasty.” Plastic and Reconstructive Surgery 149(3):p 392e-409e, March 2022.