Breast reduction (BR) operation is a plastic procedure based on different surgical techniques, aiming at reducing the breast volume when it has reached an excessive size, thus worsening the quality of life of the affected women. The problem of cancer either as an incidental finding during operation or in the long term after surgery has been widely investigated in the last 20 years; specifically, the management of unexpected tumours, and the relationship between the amount of tissue removed and the cancerogenesis of the remnant gland, with or without a case-control comparison, have been the focus. The up-to-date literature concerning extra-cosmetic outcome of breast reduction surgery emphasizes improvement of both physical and psychological postoperative symptoms. The problem of occult synchronous cancer and cancer occurring in the scarred mammary gland in the long-term follow up is a very intriguing issue. In the last 20 years, some studies both on animals and humans have been addressed to the relationship between the amount of tissue removed and cancerogenesis of the remnant gland, with or without case-control investigation. Our review evaluates the incidence and relationship between breast reduction and cancer, either in terms of intra-postoperative cancer observation or of the curative potential of breast reduction techniques when cancer arises in hypertrophied glands. There is some significant evidence that breast reduction surgery does decrease the risk for breast (up to 48%) and other types of cancers in many cases, the actual risk being lower for patients older than 40-yearsold, and depending on the amount of tissue removed. Breast reduction surgery is, partially, a tumour preventive operation in those patients presenting various degrees of breast hypertrophy and some evidence of breast cancer in parents or relatives, and also allows contralateral symmetry aft er mastectomy and reconstruction. Its tumour-preventing potential would hopefully be increased, if a subcutaneous nipple sparing mastectomy might be enclosed in the reduction protocol, with a suitable technique. The authors reviewed the available clinical studies (Tables 87.1-87.3) trying to outline an adequate preintraoperative diagnostic protocol, and to design the future trends of the procedure from the oncologic point of view.
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