Is a Breast Tissue Biopsy Mandatory with a Mastopexy?

        A breast lift specimen that consists of only skin  usually does not merit pathological evaluation.

 

 

 

Kenneth Hughes, MD Los Angeles, CA

If your PS removes mostly skin and minimal tissue, then no biopsy is sent. If more tissue is removed that includes breast tissue, I would send to pathology just to rule out a cancer.   

Some hospitals require that any breast tissue removed be sent to pathology to ruleout any breast cancer.   Generally, we all do this for breast reductions where the glandular breast tissue is removed.    
With a breast lift, skin is the only thing removed and the breast tissue is simply rearranged.  In these cases, it is usually not necessary to send the skin specimen.

I would recommend contacting your plastic surgeon for their opinion and recommendations.

Dr. Gill

It would be common to have the breast tissue examined in an insurance-covered breast reduction but not in a cosmetic breast lift. In the truest form of a breast lift, only skin is removed and there would be no reason to have that pathologically evaluated. If a breast mass was discovered during surgery, however, it would be appropriate to send it for evaluation.

In most mastopexies, some tissue is removed in the contouring of the breast. If this is the case, sending the tissue to be evaluated by a pathologist is done by some surgeons.

A breast biopsy is NOT mandatory for breast lifts, reductions, or augmentations. Some hospitals have policies on this that require all tissue be sent for a biopsy but it usually excludes these types of cases. However, if your surgeons finds something unusual during surgery, then it is appropriate to biopsy it. You may want to discuss this with your surgeon. 

In a standard breast lift or mastopexy only skin is removed and the breast tissue is lifted to a higher position. Even if a small amount of tissue needs to be removed to get better symmetry, the tissue does not have to be sent. A screening mammogram before surgery can help to find possible early issues of tumors as normal breast tissue sent rarely shows abnormal findings.

With most mastopexy procedures no breast tissue is removed.  If there is a suspicious area that was undetected prior to surgery then this would be sent to pathology.  In general it is good practice to send breast tissue with a procedure like a breast reduction or if a breast lift if a significant amount of breast tissue is removed.  Sometimes this is left up to the best judgement of the plastic surgeon.  

A breast biopsy is not necessary with a breast lift. In fact, if your surgeon is doing a true breast lift (i.e., not taking any breast tissue, just skin), it would be silly. I used to work at a hospital where all discarded tissue (including tummy tuck skin) was sent to pathology for disposal, and the pathologists would "examine" the tissue and submit a bill to the patient. I would instruct my patients to ignore any bills for such activity. It is pretty common to submit breast reduction specimens to pathology, because there have been a few cases reported of early breast cancer found in the resected specimen-- but even with that, the incidence of finding anything is extraordinarily low. You would not be getting a breast biopsy anyway, so you have every right to refuse to consent to biopsy now.  It wasn't clear from your question exactly WHO was charging you- I assume that was either a hospital or pathologist bill; if that was from your surgeon (which I sincerely doubt) then I would consider that a red flag.

Good luck!

Matthew Concannon MD

We cannot think of any reason to complete a breast biopsy at the time of a breast lift. If you are in need of a mammogram, or have an issue, lump, cyst, etc. these things are best sorted out before a cosmetic procedure. Seems to be a red flag here. You might consider a second opinion.