The ASPS News Brief section has two updates listed related to breast reductions regarding papers presented at last week’s American Society of Plastic Surgeons (ASPS) Plastic Surgery 2009 conference which I wasn’t able to attend. According to ASPS statistics, nearly 89,000 breast reductions were performed in 2008, up 5 percent since 2000.
The first one is a pilot study conducted to “determine the extent to which reduction mammaplasty surgery produces a change in biomechanical stress of the spine and level of disability in women
with macromastia.”
In the study, eleven women (ages 27 to 71 yrs, mean age 44.18) who had been determined to need breast reduction surgery, participated in a biomechanical analysis/task that involved lifting a 5 lb. weight and responded to a questionnaire prior to and following their surgery (at one week and at 3 months).
The biomechanical analysis included performance of 3-trials of a lifting task using a 5 lb. weight located 12 in. anterior to the feet and 16 in. above the ground. Concurrent kinematic and kinetic data from the task was collected using a 6-camera motion capture system (Vicon; Centennial, Co) and an in ground force-plate (AMTI; Watertown, MA). A custom made application (Matlab: Natick, MA) was used to calculate the total compressive forces at the low back using an inverse dynamic approach based on Zatiorsky's anthropometric data. Functional analysis consisted of the completion of the standardized Function Rating Index (FRI) questionnaire to assess their self-reported ability to perform dynamic movements of the neck and back and/or withstand static positions.
The results of the study showed an average maximum low back compressive force during the lifting task decreased 35% post surgery. The scores on the functional rating index improved 76% . The authors concluded “The results from this study combined with previous research demonstrate that women who undergo medically necessary reduction mammaplasty surgery may be at a decreased risk for disc degeneration and low back disorders. These results warrant additional research to prospectively investigate these individuals.”
The authors of the second one concluded that increased testing in breast reduction patients can help to identify patients at-risk of breast cancer, especially patients over 40. The reported incidence of occult breast cancer in reduction mammoplasty patients (RMP) ranges from 0.06% to 4.6% in the literature.
The study authors state, “No standard pathology assessment for RMP exists.” It is however standard that breast tissue be sent to pathology for testing regardless of the patient’s age. Perhaps our pathologist who blogs at Methodical Madness could weigh in on the standard sampling.
Two-hundred-two cases were evaluated over a 20-month period at a single institution. None of these women had any lesions identified on their pre-operative mammograms. Significant pathologic findings (SPF), i.e. carcinoma and atypical hyperplasia, were present in 12.4% of patients. Of the 202 cases, 4% were found to have carcinoma. When age of the patients was considered, the rate of carcinoma increased to 6.2% in patients over 40 years and to 7.9% in those over 50 years of age.
The authors suggests “ indicating the need for thorough sampling of RMP specimens in patients older than 40.” What would thorough sampling be as they indicated that no standard exists?
REFERENCES
American Society of Plastic Surgeons News Brief (October 25, 2009)
"The Impact of Breast Reduction Surgery on the Low Back Compressive Forces and Function in Individuals with Macromastia" presented Sun., Oct. 25, 10:25 - 10:30AM PDT, at the Washington State Convention and Trade Center. (pdf file of abstract)
"Carcinoma and Aypical Hyperplasia in Reduction Mammaplasty: Increased Sampling Leads to Increased Detection: A Prospective Study" presented Sun., Oct. 25, 10:30 -10:35AM PDT, at the Washington State Convention and Trade Center.
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