Therapeutic mammaplasty does not increase false positive findings on surveillance mammography and ultrasound

Background and Purpose: Therapeutic mammaplasty using a Wise pattern reduction has entered the mainstay of level 2 oncoplastic breast conserving surgical technique. This versatile technique allows wider margin resection whilst maintaining a natural breast form for patients with excess breast tissue. There has been conjecture that the wider tissue dissection and tissue rearrangement may lead to larger areas of scarring, fat necrosis, and seroma, which may lead to greater false positive surveillance imaging findings, leading to unnecessary investigation and patient anxiety. Method: This retrospective analysis of a prospectively maintained database included all consecutive patients who underwent Wise pattern therapeutic mammaplasty between January 2018 and June 2022 by five oncoplastic breast surgeons and three plastic surgeons over two centres. Surveillance mammograms and ultrasound were reviewed by two breast radiologists and quantitative analysis was performed Results: 39 patients met inclusion criteria. Median follow-up was 32 months. A total of 169 mammograms and 87 sonographic studies were reviewed. Breast density ranged from A to C. Mammographic findings included scar (72%), calcifications (15% new, 23% old, all benign), skin thickening 23%, and fat necrosis (5%). Sonographic findings included seroma (33%), new cyst (13%) and prominent glandular tissue (13%). No patients required tissue biopsy. Conclusion: Whilst postoperative changes are present in therapeutic mammaplasty techniques, these do not increase false positive imaging findings on postoperative surveillance mammography or ultrasound. References: 1. Piper M, Peled AW, Sbitany H, Foster RD, Esserman LJ, Price ER. Comparison of Mammographic Findings Following Oncoplastic Mammoplasty and Lumpectomy Without Reconstruction. Ann Surg Oncol. 2016 Jan;23(1):65-71. doi: 10.1245/s10434-015-4611-3. Epub 2015 May 21. PMID: 25994209. 2. Piper ML, Esserman LJ, Sbitany H, Peled AW. Outcomes Following Oncoplastic Reduction Mammoplasty: A Systematic Review. Ann Plast Surg. 2016 May;76 Suppl 3:S222-6. doi: 10.1097/SAP.0000000000000720. PMID: 26808743.