BREAST Mastectomy Scars following Breast Reconstruction: Should Routine Histologic Analysis Be Performed? Robert M. Warner, M.R.C.S. David L. Wallace, M.R.C.S. Nicholas A. Ferran, M.R.C.S. Ertan Erel, F.R.C.S. Alan J. Park, F.R.C.S.(Plast.) Daniel J. Prinsloo, F.C.S.Plast.(S.A.) Ruth Waters, F.R.C.S.(Plast.) Stoke-on-Trent, Nuneaton, and Birmingham, United Kingdom Background: There is some debate in the recent literature regarding the rou- tine submission of mastectomy scars for histologic analysis when performing delayed breast reconstructions. The aim of this study was to review the relevant publications and evaluate the practice of routine histologic examination of mastectomy scars. Methods: The authors conducted a retrospective review, across three regional plastic and reconstructive surgery units, of 433 patients who had 455 scars routinely sent for histologic examination following delayed breast reconstruc- tion between January of 2000 and December of 2006. Patients with clinical evidence of recurrent carcinoma were excluded. Results: Data from 433 patients revealed an average age at reconstruction of 49.9 years (range, 25 to 77 years). The mean interval from primary breast surgery to reconstruction was 3.9 years (range, 2 months to 32 years), and the average length of patient follow-up, from primary surgery, was 6.4 years (range, 1 to 40 years). The majority of the initial operations were carried out for invasive carcinoma (89 percent). Four mastectomy scars in three patients were positive for carcinoma recurrence. Conclusions: The publications related to the practice of routine histologic analysis of mastectomy scars provide conflicting conclusions. As a proportion of patients may benefit from the early detection and treatment of locoregional recurrence, the authors suggest that the routine submission of mastectomy scars will allow for the earlier detection of soft-tissue recurrences that may affect long-term outcome. In keeping with cancer surgery principles, the authors recommend routine histologic examination of mastectomy scars following de- layed breast reconstruction. (Plast. Reconstr. Surg. 123: 1141, 2009.) S urgeons are commonly faced with the ques- tion of whether or not a surgical specimen should be submitted for histologic analysis. This decision is often simple when a diagnosis is unknown or malignancy is suspected. When le- sions are clinically benign, the decision to send specimens for histologic analysis is unclear, and in this regard, the Royal College of Pathologists (United Kingdom) has published guidance: “His- topathology and Cytopathology of Limited or No Clinical Value.” 1 With reference to breast reduction specimens, the document questions the value of random his- tologic sections and the number of blocks that should be taken from the processed breast tissue. Mastectomy scars are not discussed in this guid- ance document. The practice of routine histologic examination of mastectomy scars at the time of delayed breast reconstruction has been ques- tioned by Soldin et al., 2 and several subsequent From City General Hospital, George Eliot Hospital, and Selly Oak Hospital. Received for publication June 19, 2008; accepted November 3, 2008. Presented at Birmingham’s National Plastic and Burns Sur- gery Scientific Meeting, in Birmingham, United Kingdom, October of 2007; the 14th International Congress of the International Confederation for Plastic, Reconstructive, and Aesthetic Surgery, in Berlin, Germany, June 26 through 30, 2007; and the 18th Annual Meeting of the European As- sociation of Plastic Surgeons, in Ghent, Belgium, May 24 through 26, 2007. Copyright ©2009 by the American Society of Plastic Surgeons DOI: 10.1097/PRS.0b013e31819f25d5 Disclosure: The authors have no financial inter- ests to disclose. www.PRSJournal.com 1141