Overuse of Preoperative Mammography in Breast Reduction Surgery: Identifying Low-Value Care.

Abstract

Preoperative mammography in patients under 40 undergoing nononcologic breast reduction surgery is not recommended by national guidelines, including the 2014 ASPS Choosing Wisely statement. This study evaluated national trends, predictors, and downstream consequences of preoperative mammography in this population. We performed a retrospective cohort study using the 2014-2021 Merative MarketScan database to identify women undergoing reduction mammaplasty for macromastia. We excluded patients with any prior breast disease or family history. Mammograms within 12 months preoperatively were identified and stratified by age and type (screening vs. diagnostic). Downstream imaging, biopsies, and new breast-related diagnoses within 3 months were assessed. Multivariable logistic regression was used to identify predictors of mammography among patients under 40. Among 15,394 reduction mammaplasty patients, 31% received a preoperative mammogram, including 9.3% of women under 40. In this younger cohort, rates decreased from 12.9% in 2014 to 7.7% in 2021. Women ages 18-29 and 30-39 undergoing surgery were 8- and 3-times more likely, respectively, to receive a mammogram compared to age-matched general populations. Among women under 40, increasing age, urban residence, and Southern location predicted higher mammography use. Downstream testing occurred in 15% of screening mammograms and 43% of diagnostic mammograms in this group. Despite improvements since 2014, preoperative mammography remains overused in women under 40 undergoing breast reduction, exposing patients to low-value care and potential harm. Targeted deimplementation strategies are needed to align practice with evidence-based guidelines.