Published 10 March 2009, doi:10.1136/bmj.b630
Cite this as: BMJ 2009;338:b630

Analysis

Tissue screening after breast reduction

Mohammed Keshtgar, consultant breast surgeon1, Alireza Hamidian Jahromi, clinical fellow in breast surgery 1, Tim Davidson, consultant breast surgeon1, Paula Escobar, clinical fellow in breast surgery 1, Patrick Mallucci, consultant plastic surgeon 1, Afshin Mosahebi, consultant plastic surgeon 1, Michael Baum, emeritus professor of breast surgery 1

1 University Department of Surgery, Royal Free Hampstead NHS Trust and Royal Free and University College Medical School, London NW3 2QG

Correspondence to: M Keshtgarmo.keshtgar@royalfree.nhs.uk

Patients who undergo breast reduction surgery have a low risk of being found to have breast cancer, but they need to be made aware of it—and doctors need to debate whether routine histological examination of tissue specimens is a good idea. We sought the views of Tom Treasure, a surgeon (doi:10.1136/bmj.b759), Jeremy Sugarman, an ethicist (doi:10.1136/bmj.b753), and Tessa Boase, a lay person (10.1136/bmj.b776)

The first 150 words of the full text of this article appear below.

Reduction mammoplasty is one of the most common procedures performed by plastic surgeons all around the world.1 For decades, it has been a common practice to send even normal looking surgical specimens for histopathological analysis because of the possibility of finding asymptomatic breast cancer. A postal questionnaire sent to consultant members of the British Association of Plastic Surgeons in 1994 found that 89% routinely sent breast reduction tissue for histopathology, and 42% of respondents had seen at least one case of breast cancer from these tissues.2

Pathological findings of breast cancer at the time of reduction mammoplasty have been reported.3 In 1960 the incidence of breast carcinoma found after breast reduction surgery was reported to be 0.38%.4 In different series, occult carcinoma has been found in 0.05-1.66% of breast reduction specimens, and the chance of finding such a cancer is affected by thoroughness of preoperative and postoperative examinations.5 Other authors . . . [Full text of this article]


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This article has been cited by other articles:

  • Douglas-Jones, A. G, Varma, M. (2009). More than a little extra work. BMJ 338: b2342-b2342 [Full text]  
  • Sugarman, J. (2009). Commentary: A call for preventive ethics. BMJ 338: b753-b753 [Full text]  
  • Treasure, T. (2009). Commentary: The big question remains unanswered. BMJ 338: b759-b759 [Full text]  

Rapid Responses:

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Needless convolutions
peter j mahaffey
bmj.com, 11 Mar 2009 [Full text]
Pre-operative assessment
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bmj.com, 12 Mar 2009 [Full text]
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DCIS is clinically important
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Medico legal aspects
Atul Khanna
bmj.com, 6 Apr 2009 [Full text]
What about the histopathology view?
Anthony G Douglas-Jones, et al.
bmj.com, 3 Jun 2009 [Full text]
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