Is It Safe to Have a Second Breast Reduction with a Family History of Cancer?

I had a breast reduction at 18. I went from a 34FF to a 34C,big C. Ten years, two kids later my breast are now at 38DD. I'm 5'1 and weigh about 150 lbs. Even with weight lost, was 186 my breast have not decreased. I've been having neck and back pain to name a few. Is it safe to undergo another breast reduction when I have a high family history of cancer, with my sister having breast cancer? Overall I'm in great health but could my family hx be a health hazard to me?

Doctor Answers 4

Repeat Breast Reduction

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In women with Juvenile Breast Hypertrophy (macromastia in adolescence), an early breast reduction may be required to treat severe symptoms. In these women, the hormonal receptors on the breast tissue are extraordinarily sensitive to the effects of estrogen, resulting in breast hypertrophy (enlargement). Even though breast tissue is removed in an initial breast reduction procedure, the remaining breast tissue continues to grow and develop. A subsequent breast reduction (reduction mammaplasty) may be required.

If a repeat reduction is considered, it is paramount for the plastic surgeon to have the previous operative records from the initial surgery. If the type of operation initially performed is not understood, the nipple areolar complex may be stripped of its blood supply in a subsequent procedure. The nipple can be partially or completely lost as a result.

In general, smaller breasts are more easily evaluated for breast cancer (both via physical examination and mammography).  In addition, recent studies have shown that because a woman has less breast tissue after surgery, she less likely to develop cancer in the future (relative risk reduction of 28%) . Furthermore, the breast tissue removed in the repeat reduction procedure is evaluated microscopically by a pathologist.  Occult breast cancer is observed in approximately 1% of breast tissue removed in breast reduction procedures.

Prior to embarking on any surgical intervention, it may be helpful for you to meet with a surgical oncologist. They will be suited to evaluate your personal risk of cancer and potentially determine if you have a genetic marker in your family that predisposes you to breast & ovarian cancer (i.e. BRCA1/2 genes). This decision is a sensitive one, and there is no correct answer. A board certified plastic surgeon can always help to guide your decision-making process.


No cancer risk in a redo of breast reduction

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There should be no problem having a second breast reduction and it may make your breasts easier to visualize with a mammogram.  There would be no increase or decrease in you risk for breast cancer due to a second breast reduction.

A redo reduction mamoplasty should be fine since it has been so many years since the first reduction

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While it would be nice to know the technique used in the first reduction mamoplasty there should not be any real problem with a second reduction so many years later. As to the breast cancer in your family, most breast cancer is sporadic and not genetic. You should check to see if you have any other females on your Mother's side who had breast cancer and if there is any question then may be a genetic work up would be indicated. You should probably have a mammogram. If there is no other family history and your mammogram is clear then there should not be a problem proceeding with a second reduction mamoplasty. You should get to your ideal body weight before surgery and there should be no smoking or tobacco exposure. 

Repeat breast reduction

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If you are healthy enough for an elective procedure, a second breast reduction is safe. Each time tissue is removed, you are decreasing your chances of breast cancer. Plus, the tissue removed will be evaluated by a pathologist.  Also, a smaller breast is easier to examine by examination and mammography.  You might want to discuss your concerns with a plastic surgeon in your area.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.