Reduction Mammoplasty

Case 27.1: Architectural Distortion

Case History

A 61-year-old woman had reduction mammoplasty 2 years ago.

Physical Examination

• Bilateral breasts: bilateral reduction scars, otherwise normal

Mammogram (Figs. 27.1 and 27.2)

Fig. 27.1 Normal mammogram prior to reduction mammoplasty. (A) Left MLO mammogram. (B) Left CC mammogram.

Fig. 27.2 Normal mammogram 2 years after reduction mammoplasty. The nipple (N) is higher in position, and the contour of the breast is flatter. Architectural distortion has resulted in swirled lines (small arrows); disruption of the normal subareolar ductal lines (large arrows); and increase in the density of the inferior breast, which in this patient is associated with straight parenchymal bands (arrowheads). (A) Left MLO mammogram. (B) Left CC mammogram.

Pathology

• Changes from reduction mammoplasty

Management

• BI-RADS assessment category 2, benign finding

Pearls and Pitfalls

• The various reduction mammoplasty procedures involve removing tissue from the inferior breast. The residual upper breast tissue is brought together in the midline to reform a smaller breast, and the nipple areolar complex is transposed superiorly. After these procedures, mammograms exhibit the following findings: (1) elevation of the nipple with flattening of the breast contour, (2) architectural distortion, (3) fat necrosis, (4) dystrophic calcifications, and (5) skin thickening.

Case 27.2: Architectural Distortion

Case History

An 85-year-old woman presents for screening mammogram.

Physical Examination

• Bilateral breasts: reduction mammoplasty scars, otherwise normal

Mammogram (Fig. 27.3)

Fig. 27.3 Bilateral normal mammograms after reduction. Architectural distortion from reduction has resulted in asymmetry in both the anterior and posterior contours of the breasts. There are unusual indentations in the parenchymal outline (arrows

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