Long-Term Outcomes and Oncologic Implications of Histopathological Findings in Breast Reduction Specimens: A 15-Year Follow-Up Study

Abstract Background Breast reduction surgery provides both functional and aesthetic benefits and enables incidental detection of breast pathology. Although high-risk or malignant lesions are uncommon, their long-term clinical relevance remains unclear. Objectives The aim of this study was to evaluate the histopathological findings of breast reduction specimens and assess their relationship with long-term breast outcomes, including the development of new breast disease and the need for subsequent biopsy or mastectomy. Methods This retrospective cohort study included 1349 patients (2630 breasts) who underwent breast reduction with a minimum 5-year follow-up. Long-term clinical outcomes were assessed only in the subset of 377 patients (731 breasts) who completed a follow-up questionnaire. Histopathological findings were classified into 3 risk categories according to their association with malignancy. A follow-up questionnaire assessed breastfeeding ability, adherence to imaging, and the occurrence of new breast masses or interventions. Associations between baseline risk category, follow-up duration, and long-term outcomes were analyzed using Pearson χ2 tests. Results High-risk or malignant lesions were identified in 1.3% of specimens, predominantly among women over 40 years. Specimen weight and previous contralateral breast cancer history were not associated with pathological risk. Among 731 breasts evaluated by questionnaire, 80.1% retained breastfeeding ability, whereas 38% reported no imaging follow-up. Biopsy incidence increased significantly with follow-up time (2.6%, 6.2%, and 13.8% at 5-10, 10-15, and >15 years; P < .001). Mastectomy rates also rose with time (0%, 0.6%, and 8.3%; P < .001), showing a trend toward higher incidence in baseline high-risk specimens. Conclusions Breast reduction surgery facilitates incidental detection of high-risk lesions, particularly in women over 40 years. Higher baseline pathological risk and longer follow-up were associated with increased likelihood of mastectomy, underscoring the need for structured, risk-adapted surveillance to optimize long-term oncologic safety. Level of Evidence: 3 (Therapeutic)