Reduction Mammaplasty in a Patient with Prior Breast Cancer
A 39-year-old woman requests bilateral reduction mammaplasty for symptomatic macromastia (bra size 38H, chronic back and shoulder pain, intertrigo). Ten years ago she had left breast-conserving surgery with radiation for early-stage invasive ductal carcinoma; she has been disease-free since. She is BRCA-negative. Examination shows significant asymmetry (left breast smaller and firmer with radiation changes) and a prior lumpectomy scar in the upper outer quadrant. She wants symmetry and symptom relief.
1. How does her prior breast cancer and radiation affect your surgical planning and consent?
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Prior radiation makes the left breast less compliant, with higher risk of poor wound healing, fat necrosis, and asymmetry; the left breast may require a different pedicle or a more conservative resection. The right breast can be reduced to match the left, but achieving symmetry may require staging or a free nipple graft on the radiated side. Obtain oncology clearance and confirm no recurrence with imaging per protocol. Consent must address: higher complication risk on the radiated side, possible need for revision, asymmetry, and the possibility that the final result differs from a standard reduction. Document that she understands these risks.
2. What are the key oncologic surveillance considerations before and after surgery?
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Before surgery: confirm current disease-free status with the oncology team and appropriate imaging (mammography/breast MRI per institutional protocol), especially given the prior lumpectomy and radiation. Ensure the reduction specimen is sent for pathologic evaluation - occult carcinoma can be found in reduction specimens, and the radiated side warrants careful margin assessment. After surgery: coordinate follow-up with oncology; any new mass or skin change should be evaluated promptly. The judgment is that aesthetic surgery in a cancer survivor must be integrated with oncologic surveillance, and the specimen must be pathologically examined.