Breast reduction before mastectomy

As far as I know, the risk is the same if you have one area of LCIS or many areas of LCIS. So if there is any LCIS remaining after the breast reduction (which is very likely since LCIS is thought to be multifocal, multicentric, and bilateral in nature), the risk would likely remain the same.  Larger breasted women are not at greater risk with LCIS than smaller breasted women; the risk with LCIS is not dependent on the size of the breasts. And since LCIS is not often seen on any imaging, they would not know where it was located specifically, and therefore not be able to remove it all.

Anne 

I was diagnosed with LCIS in August.  I decided I was not going to sit around and hope to be spared, but I want a mastectomy on my terms: nipple-sparing, skin-sparing.  So, since I had very large breasts (DDD), I decided to undergo a reduction (was going to do it anyway, had the surgery date back in August, but then was diagnosed with LCIS -they saw calcifications on my annual mammogram).  I now have beautiful 36C breasts:)  Pathology showed no remaining LCIS.  Going to wait 6 months, have my mammogram and MRI and if they tell me they want another biopsy, I am going for a PBM.  I agree with others who say a reduction per se would not necessarily lower your risk, although there are studies in Europe that point to the opposite... Either way, if you want to have your nipples spared AND have large breasts, a reduction before a mastectomy is a way to go, at least in my opinion.  Feel free to email me if you have any questions and good luck:)

Tatiana

There is some (limited) evidence that women with smaller breasts at a young age have a decreased incidence of premenopausal cancer in leaner women.  http://www.ncbi.nlm.nih.gov/pubmed/16284954  This is a more complex subject than one would think, because obesity is a known risk factor for breast cancer, and if one is obese, one tends to have larger breasts, so they sometimes use BMI in addition.

This paper found an association between breast size in lean women before pregnancy and postmenopausal breast cancer. http://www.ncbi.nlm.nih.gov/pubmed/10231159

But, these are not strong associations, and do not apply to average or fatter women.  In addition, we don't know if they apply to LCIS women.  We have no idea how LCIS works - how the presence of LCIS (even when present in one breast only) puts BOTH breasts at risk.  (LCIS is usually multifocal-meaning there are usually multiple spots of LCIS in a breast - and often bilateral - meaning it is often found in both breasts.) Most LCIS is diagnosed in women in their 40s or 50s.

Because LCIS is normally ONLY detected by looking at a piece of tissue under the microscope, it is hard to know how many spots of LCIS remain in LCIS (and nothing worse) women who keep their breasts.

Since the women who have LCIS and go on to get DCIS or invasive often get the DCIS or invasive at a spot that looked perfectly normal on imaging, we don't know if reduction in breast tissue would decrease that risk. 

Notably, in the Chuba study, excision (partial mastectomy) in LCIS in one breast produced approximately an EQUAL distribution of breast cancer is each breast.

"For patients having partial mastectomy, the frequency of subsequent ipsilateral and contralateral IBC was nearly identical 5 to 25 years after LCIS. A substantial proportion of patients had mastectomy (n = 1,281), and as expected, this intervention was associated with dramatic (although not complete) reduction in the rate of ipsilateral occurrences of IBC, with less than 0.5% to 1.0% ipsilateral IBC 15 to 25 years after mastectomy (P < .001). "  http://www.ncbi.nlm.nih.gov/pubmed/7834439  So in this case, reduction of (some) breast tissue did NOT reduce risk substantially in the ipsilateral breast.  If breast reduction decreased breast cancer risk in the ipsilateral breast, then you'd expect to find an unequal risk of breast cancer between the ipsilateral and contralateral breast.

Now, few patients in this Chuba study got breast cancer, and fewer have been followed for 25 years.  I don't know if the partial mastectomies performed would reduce breast tissue by the same amount as breast reduction.  So its very hard to make definite statements, and as in all things LCIS most is controversial.  But its the most longterm data that I know of for LCIS women.