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      Current practices of plastic surgeons at King Abdulaziz University Hospital in requesting breast imaging studies prior to non-oncological breast surgeries

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          Abstract

          Background

          In the context of the high incidence of breast cancer and the high frequency of breast cosmetic surgeries, malignant and/or premalignant lesions are frequently detected incidentally in postoperative histopathology specimens. The current literature does not provide clear practice guidelines for the use of preoperative imaging prior to non-oncological breast surgeries.

          Objectives

          In this study, we aimed to determine the current practices of plastic surgeons at King Abdulaziz University Hospital (KAUH) and their use of preoperative breast imaging before non-oncological breast surgeries.

          Design

          Non-intervention/ retrospective record review.

          Settings

          Department of Radiology at King Abdulaziz University Hospital (KAUH).

          Methods

          In 08/06/2017 at King Abdulaziz University Hospital, we conducted a single-center, retrospective chart review of the medical files of candidates for non-oncological breast surgery in order to examine preoperative imaging requests by plastic surgeons in the period 01/01/2013 to 08/06/2017.

          Main outcome measures

          The practice of plastic surgeons at KAUH in requesting preoperative imaging prior non-oncological breast surgeries.

          Sample size

          104 patients.

          Results

          We found that, in the period 2013 to 2017, 104 women who underwent non-oncological breast surgeries were evaluated for recent preoperative breast imaging. Only 37 patients (35.6%) were found to have had preoperative imaging, and only less than one fifth (19.4%) of those 37 patients had abnormal preoperative imaging results, all of which were negative for malignancy.

          Conclusions

          Although the yield of malignancy on preoperative breast imaging was zero in women seeking non-oncological breast surgeries at KAUH, we recommend the establishment of unified practice guidelines to be followed by plastic surgeons for better postoperative screening in different risk groups.

          Limitations

          Lack of follow up of patients postoperatively for any development of malignancy.

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          Most cited references4

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          Effect of breast augmentation on the accuracy of mammography and cancer characteristics.

          Breast augmentation is not associated with an increased risk of breast cancer; however, implants may interfere with the detection of breast cancer thereby delaying cancer diagnosis in women with augmentation. To determine whether mammography accuracy and tumor characteristics are different for women with and without augmentation. A prospective cohort of 137 women with augmentation and 685 women without augmentation diagnosed with breast cancer between January 1, 1995, and October 15, 2002, matched (1:5) by age, race/ethnicity, previous mammography screening, and mammography registry, and 10 533 women with augmentation and 974 915 women without augmentation and without breast cancer among 7 mammography registries in Denver, Colo; Lebanon, NH; Albuquerque, NM; Chapel Hill, NC; San Francisco, Calif; Seattle, Wash; and Burlington, Vt. Comparison between women with and without augmentation of mammography performance measures and cancer characteristics, including invasive carcinoma or ductal carcinoma in situ, tumor stage, nodal status, size, grade, and estrogen-receptor status. Among asymptomatic women, the sensitivity of screening mammography based on the final assessment was lower in women with breast augmentation vs women without (45.0% [95% confidence interval [CI], 29.3%-61.5%] vs 66.8% [95% CI, 60.4%-72.8%]; P =.008), and specificity was slightly higher in women with augmentation (97.7% [95% CI, 97.4%-98.0%] vs 96.7% [95% CI, 96.6%-96.7%]; P<.001). Among symptomatic women, both sensitivity and specificity were lower for women with augmentation compared with women without but these differences were not significant. Tumors were of similar stage, size, estrogen-receptor status, and nodal status but tended to be lower grade (P =.052) for women with breast augmentation vs without. Breast augmentation decreases the sensitivity of screening mammography among asymptomatic women but does not increase the false-positive rate. Despite the lower accuracy of mammography in women with augmentation, the prognostic characteristics of tumors are not influenced by augmentation.
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            Incidence of precancerous lesions in breast reduction tissue: a pathologic review of 562 consecutive patients.

            Reduction mammaplasty is the fifth most common reconstructive surgical procedure in the United States. The incidence of invasive breast cancer in breast reduction specimens is between 0.06 and 0.4 percent. However, the incidence of atypical hyperplasia and other precancerous lesions is not well described. The authors conducted a single-center retrospective chart review examining the incidence of benign and precancerous lesions in breast reduction specimens over a 5-year period. Of the 562 patients who underwent reduction mammaplasty, 52.7 percent had nonproliferative or proliferative breast lesions. Twenty-five patients (4.4 percent) had a specimen containing atypical ductal or lobular hyperplasia. Six patients (1.1 percent) had ductal carcinoma in situ and four patients (0.7 percent) had lobular carcinoma in situ. No occult invasive breast cancer was identified in the breast reduction specimens, but one patient with ductal carcinoma in situ was found to have invasive breast cancer on completion mastectomy (0.2 percent). This study demonstrates the importance of systematic analysis of breast reduction specimens to help identify and guide the management of patients with increased risk of breast cancer following reduction mammaplasty.
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              The role of preoperative mammography in women considering reduction mammoplasty: a single institution review of 207 patients

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                Author and article information

                Contributors
                Journal
                Saudi J Biol Sci
                Saudi J Biol Sci
                Saudi Journal of Biological Sciences
                Elsevier
                1319-562X
                2213-7106
                17 March 2021
                June 2021
                17 March 2021
                : 28
                : 6
                : 3505-3510
                Affiliations
                [a ]Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
                [b ]Department of Radiology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
                Author notes
                [* ]Corresponding author at: Faculty of Medicine, King Abdulaziz University, P.O Box 5203, Nafee bin Alhareth, Jeddah 22431, Saudi Arabia. lama.meriky@ 123456hotmail.com
                Article
                S1319-562X(21)00189-3
                10.1016/j.sjbs.2021.03.018
                8176043
                765181c8-86f2-4d6b-90da-20911f00c0c6
                © 2021 Published by Elsevier B.V. on behalf of King Saud University.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 4 March 2020
                : 5 March 2021
                : 7 March 2021
                Categories
                Original Article

                preoperative breast imaging,preoperative mammogram,breast cosmetic surgeries

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