Routine Histologic Examination of 728 Mastectomy Scars: Did It Benefit Our Patients?

Sir: I read with interest the article by Woerdeman et al.1 published in the November 2006 issue of the Journal. On the basis of this review of 728 mastectomy scars that were histologically examined for metastases, the authors concluded that “routine submission of clinically unsuspected scars excised at the time of breast reconstruction or scar correction after prophylactic or curative breast surgery did not benefit our patients,” because in no case was there evidence of malignancy. This made me reflect on my current practice, because I routinely send all mastectomy scars to the pathology department for histological analysis. Having now performed more than 1000 breast reconstructions, I would like to comment on two women: one with a benign-appearing mastectomy scar and the other with a benign-appearing breast implant capsule. In the first woman, a transverse rectus abdominis musculocutaneous flap had been used to reconstruct a left breast following mastectomy and radiation. At a secondary revision 6 months later, the benign-appearing lateral scar was excised and submitted for histological analysis. The analysis demonstrated tumor cells within the scar itself. In the second woman, a tissue expander was used to reconstruct a breast following mastectomy. During the implant exchange, a benign-appearing capsule was submitted for analysis, which demonstrated tumor cells within the capsule. In both women, appropriate oncologic management was initiated and completed. There is no doubt that the routine histologic examination of benign-appearing scar tissue on or within the breast was beneficial to these two women. Maurice Y. Nahabedian, M.D. Georgetown University 3800 Reservoir Road N.W. Washington, D.C. 20007 [email protected]