Is there any role of reduction mammoplasty in decreasing breast cancer risk in gigantomastia?

Aim: Large breasts create psychological and physical problems in women, all of whom must also keep in mind the common problem of breast cancer. In the present study we examine the effect of breast reduction surgery on breast cancer risk. Materials and Methods: Our retrospective study is based on the records (between June 1, 2014, and June 30, 2019) of patients who underwent breast reduction surgery in the Plastic, Reconstructive and Aesthetical Surgery clinic of a training and research hospital. Statistical analyses were conducted using IBM SPSS Statistics (Version 25.0. Armonk, NY: IBM Corp.). Normal distribution of the data was analyzed with Kolmogorov-Smirnov. The data assessment included descriptive statistical methods and Kruskal-Wallis test. The results were evaluated at a 95% confidence interval and a significance level of p < 0.05. Results: Of the 134 patients included in the study, 47% were aged 36–50 years and 60.4% had a body mass index of 40. The shortest follow-up was 4 years, the longest follow-up was 9 years and the mean follow-up was 5.5 years. The mean amount of tissue removed from the right breast was 1050.54±484.90, the mean amount of tissue removed from the left breast was 1059.54±522.28, and the mean length of hospital stay was 1.15±0.74 days. The pedicle of choice was superomedial in 55.2% and the inverted-T scar technique was used in 66.4%. Definitive findings of neither in-situ nor invasive cancer were identified in any of the cases. Conclusion: Despite major sequelae such as external permanent scarring and decrease in breastfeeding and nipple sensation, breast reduction surgery is the operation that records the highest patient satisfaction in plastic, reconstructive and aesthetica surgery, as it provides physical and psychological relief by eliminating the heavy weight that affects the shoulders, back and neck. It is also known that the risk of breast cancer is decreased due to the removal of a considerable amount of breast tissue with cancer potential from the body, as well as the early diagnosis and treatment of incidentally detected cancer cases, albeit at a low rate. This is also supported by our findings.

PDF

___

1. Ngaage LM, Bai J, Gebran S, Elegbede A, Ihenatu C, Nam AJ et al. A 12-year review of patient-reported outcomes after reduction mammoplasty in patients with high body mass index. Medicine, 2019; 98(25).
2. Kerrigan CL, Collins ED, Striplin D, et al. The health burden of breast hypertrophy. PlastReconstr Surg, 2001;108:1591-9.
3. Chadbourne EB, Zhang S, Gordon MJ, et al. Clinical outcomes in reduction mammaplasty: a systematic review and metaanalysis of published studies. Mayo Clin Proc, 2001; 76:503–10.
4. Boschert MT, Barone CM, Puckett CL. Outcome analysis of reduction mammaplasty. PlastReconstr Surg, 1996; 98:451–4. 5. Raispis T, Zehring RD, Downey DL. Long term functional results after reduction mammoplasty. Ann Plast Surg, 1995; 34:113–6.
6. Ngaage LM, Ngaage KC, Ngaage DL. The challenges of the postoperative care of obese patients. AnalgResusc: Curr Res, 2015; 4:2.
7. Wirthmann AE, Welsch L, Wellenbrock SV, et al. Reduction mammoplasty in adolescents and elderly: a ten year case series analyzing age related outcome with focus on safety and complications. J PlastReconstrAesthet Surg, 2018; 71:377–83.
8. Rowland JH, Desmond KA, Meyerowitz BE, Belin TR, Wyatt GE, Ganz PA. Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors. J Natl Cancer Inst, 2000;92:1422–9.
9. Dean C, Chetty U, Forrest AP. Effects of immediate breast reconstruction on psychosocial morbidity after mastectomy. Lancet, 1983;1:459–62.
10. Veiga DF, Sabino Neto M, Ferreira LM, et al. Quality-of-life outcomes after pedicled TRAM flap delayed breast reconstruction. Br J Plast Surg, 2004;57:252–7.
11. Stein MJ, Karir A, Arnaout A, Roberts A, Cordeiro E, Zhang T, Zhang J. Quality-of-life and surgical outcomes for breast cancer patients treated with therapeutic reduction mammoplasty versus mastectomy with immediate reconstruction. Annals of Surgical Oncology, 2020; 27: 4502-4512.
12. Ferna´ndez-Delgado J, Lo´pez-Pedraza MJ, Blasco JA, et al. Satisfaction with and psychological impact of immediate and deferred breast reconstruction. Ann Oncol, 2008;19:1430-4.
13. Wilkins EG, Cederna PS, Lowery JC, et al. Prospective analysis of psychosocial outcomes in breast reconstruction: one-year postoperative results from the Michigan Breast Reconstruction Outcome Study. PlastReconstr Surg, 2000;106:1014-25; discussion 1026–1017.
14. Corsten LA, Suduikis SV, Donegan WL. Patient satisfaction with breast reconstruction. Wis Med J, 1992;91:125–26, 129.
15. Dutra AK, Neto MS, Garcia EB, et al. Patients’ satisfaction with immediate breast reconstruction with a latissimus dorsi musculocutaneous flap. J Plast Surg Hand Surg, 2012;46:349–53.
16. Rubino C, Figus A, Lorettu L, Sechi G. Post-mastectomy reconstruction: a comparative analysis on psychosocial and psychopathological outcomes. J PlastReconstrAesthet Surg, 2007;60:509–18.
17. Al-Ghazal SK, Fallowfield L, Blamey RW. Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. Eur J Cancer, 2000;36:1938–43.
18. Setälä L, Papp A, Joukainen S, et al. Obesity and complications in breast reduction surgery: are restrictions justified. J PlastReconstr Aaesthetica Surg, 2009;62:195-9
19. Shah R, Al-Ajam Y, Stott D, et al. Obesity in mammaplasty: a study of complications following breast reduction. J PlastReconstr Aaesthetica Surg 2011;64:508-14.
20. De Azambuja E, McCaskill-Stevens W, Francis P, Quinaux E, Crown JP, et al. The effect of body mass index on overall and disease-free survival in node-positive breast cancer patients treated with docetaxel and doxorubicin-containing adjuvant chemotherapy: the experience of the BIG 02-98 trial. Breast cancer research and treatment, 2010;119(1):145-153.
21. Lees AW, Jenkins HJ, May CL et al. Risk factors and 1 0-year breast cancer survival in northern Alberta. Breast Cancer Res Treat, 1989 13:143–151
22. Hebert JR, Hurley TG, Ma Y. The effect of dietary exposures on recurrence and mortality in early stage breast cancer. Breast Cancer Res Treat, 1998; 51:17-28
23. Maehle BO, Tretli S. Pre-morbid body-mass-index in breast cancer: reversed effect on survival in hormone receptor negative patients. Breast Cancer Res Treat, 1996; 41:123–130.
24. Lim W, Ko BS, Kim HJ, et al. Oncological safety of skin-sparing mastectomy followed by immediate reconstruction for locally advanced breast cancer. J Surg Oncol, 2010;102:39–42.
25. Nguyen JT, Palladino H, Sonnema AJ, et al. Long-term satisfaction of reduction mammoplasty for bilateral symptomatic macromastia in younger patients. J Adolesc Health, 2013;53:112–7.
26. Sezgin B, Fındıkçıoglu K, Sibar S, Barut I, Ayhan S, Latifoglu O. GeçmistenGünümüzeKlinikte Meme Küçültme: GeriyeDönükKesitsel Bir Bakıs. TürkPlastikRekonstrüktifveEstetikCerrahiDergisi, 2012; 20(2): 19-22.
27. Adham A, Sawan K, Lovelace C, Jaeger NJ, Adham C. Unfavorable outcomes with vertical reduction mammoplasty: part II. Aesthet Surg J, 2011; 31(1): 40-6.
28. Jansen LA, Backstein RM, Brown MH. Breast size and breast cancer: a systematic review. Journal of Plastic, Reconstructive & Aaesthetica Surgery, 2014;67(12):1615-23.
29. Fallone F, Deudon R, Muller C, Vaysse C. Breast cancer, obesity and adipose tissue: a high-risk combination. Medecine Sciences: M/S, 2018;34(12): 1079-86.