High Risk Lesions in Reduction Mammoplasties in Patients of Hispanic Ethnicity - Incidence and Follow-up

Background: Occult high-risk breast lesions are occasionally detected in reduction mammoplasty specimens, but data in Hispanic patients are scarce. Methods: We retrospectively reviewed bilateral reduction mammoplasties performed for macromastia between January 2018–June 2020 and January–May 2023 at an academic center serving a predominantly Hispanic population. Self-identified Hispanic patients without prior breast cancer or known high-risk lesions were included. Demographic, clinical, histopathologic, and follow-up data were analyzed. Results: Of 333 Hispanic patients, 21 (6.3%) had incidental high-risk lesions: atypical ductal hyperplasia (n=9), atypical lobular hyperplasia (n=4), ALH approaching lobular carcinoma in situ (n=3), lobular carcinoma in situ (n=4), and ADH bordering on ductal carcinoma in situ (n=2). Patients with high-risk lesions were older (median 50 vs. 38 years, p=0.005) and more likely to have a family history of breast or ovarian cancer (38.1% vs. 15.7%, p=0.008). Logistic regression confirmed age (OR 1.05/year, p=0.008) and family history (OR 3.41, p=0.012) as independent predictors. Mean follow-up was 3.9 years; 2 patients (10.5%) developed invasive carcinoma, while most (71.4%) entered high-risk surveillance and 19% initiated chemoprevention. Conclusions: Among Hispanic women undergoing reduction mammoplasty, 6.3% had occult high-risk lesions—similar to rates in predominantly non-Hispanic cohorts. Older age and family history significantly increased risk. Routine histopathologic evaluation of all reduction specimens remains essential, with incidental high risk findings prompting enhanced surveillance and preventive interventions.