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Atypical hyperplasia in healthy patients after bilateral breast reduction: a single center experience at West Virginia University
Seth Noorbakhsh, Noah Hewitt, Mihail Climov MD, Kerri Woodberry MD
West Virginia University School of Medicine
2021-02-01
Presenter: Seth Noorbakhsh
Affidavit:
The material proposed for the presentation in this abstract has not been published or previously presented at a major meeting. I approve the submission.
Director Name: Kerri M Woodberry, MD
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Breast (Aesthetic and Recon.)
Atypical hyperplasia is a premalignant condition, with 30% of patients developing breast cancer within 25 years of diagnosis. Historically, treatment involves clinical observation with interval imaging, surgery, and/or anti-estrogen therapy. However, there are no unified recommendations, and treatment decisions are based on exogenous risk factors and patient preference. A retrospective chart review was performed of 360 adult women without a personal history of breast cancer who underwent bilateral breast reduction at West Virginia University hospitals between 2010-2020. Twelve surgeons performed the operations. Average age at the time of operation was 42 years (95% CI [40.7, 43.3]). Average breast weight removed per case, available for 354 patients, was 1737 grams (95% CI [1640, 1840]). Three patients with atypical hyperplasia were identified (0.83%), all atypical lobular hyperplasia. Two of these patients were referred to a cancer center, and one patient was managed by her plastic surgeon. Both cancer center patients continued annual or six-month screenings with mammography and were offered anti-estrogen therapy. The patient who followed with her plastic surgeon underwent a one-year screening mammogram but failed to follow up afterward. Previous studies have shown atypical hyperplasia to be found in 2.0-9.3% of healthy patients undergoing routine breast reduction. In our study, a lower incidence (0.83%) may be explained by a thorough pre-operative screening that includes both detailed family history and mammogram based on American Cancer Society guidelines. Though sample size is a limitation, variable management of the three patients with atypical hyperplasia in this study highlights the need to standardize care.
