0:00

Okay, this is a 62-year-old female

0:02

presenting for screening mammogram.

0:06

We can see the image quality

0:07

here, um, is sort of adequate.

0:09

Um, perhaps not great.

0:11

We don't get a great view of

0:13

the ALH muscles in each breast.

0:15

IMF is okay on the right,

0:18

probably not great on the left.

0:19

We could consider, recall this for a technical

0:22

recall, but you wanna look at prior exams

0:24

and make sure, uh, that this is persistent.

0:29

In doing that, you might see that her clinical

0:31

history, uh, includes that of, um, breast

0:35

reduction, um, which can make, uh, performing the

0:38

exam a little more difficult for technologists.

0:41

And if we saw this on multiple prior exams,

0:43

that that was the best the technologist

0:45

could do, then I would let that go as just

0:46

being part of the patient's ability to sort

0:49

of achieve our standard positioning, you know,

0:54

at this verify.

0:58

The findings do relate to prior breast reduction, but

1:02

what we typically see in reduction cases are, uh, sometimes

1:05

periareolar sort of findings with maybe occasional dermal

1:08

or calcifications in the skin would be both signs.

1:11

We see a few venous calcifications here on those.

1:13

It's difficult to tell that it's

1:14

really in that periareolar location.

1:17

And then we frequently see either, um, some thickening

1:21

or perhaps skin thickening extending inferiorly

1:24

in the inferior part of the breast.

1:26

The reason for that is that the most common breast

1:31

reduction surgery is the so-called keyhole approach,

1:34

where there's an incision made around the periareola,

1:37

um, uh, along that margin, and then going straight

1:40

inferiorly along the six o'clock axis to the IMF.

1:44

And we can see some of those findings here.

1:46

In this case, you can see some, um, sort of abnormal

1:49

appearing, uh, glandular tissue here with its

1:52

more sort of linear appearance, likely related to

1:54

some surgery in this spot, that sort of finding.

1:58

And then on the CC view, um, we do see some of

2:01

that same sort of linear, um, kind of finding here.

2:05

Um, we don't see it as well on the

2:06

right-hand side in terms of DBT stack.

2:09

Um, the imaging findings are not

2:12

particularly, um, characteristic in any

2:15

case. Um, you may see some calcifications

2:18

in the skin, which might be helpful.

2:19

We might see a little bit of skin thickening or some,

2:22

um, changes in the appearance of the parenchyma.

2:26

Um, but should all look like normal fibrous tissue.

2:31

You may notice that sometimes the pattern

2:33

of the glandular tissue appears to change

2:36

over the course of several years, um,

2:38

after the patient's had a reduction.

2:41

Um, or you might see some sort of a little bit

2:44

bizarre-looking, um, parenchymal kind of pattern

2:47

or appearance, and that's all related to surgery.

2:49

Here we can potentially, potentially see even a

2:51

little bit of architectural distortion in this

2:53

CC view that again, is related to the surgery.

2:57

If we know the patient's had a prior

2:58

reduction surgery, then this is okay.

3:00

We don't really need to do any

3:01

further workup in this case.

3:02

So in this case, we call this BI-RADS 2 and just say, um,

3:05

postoperative findings, previous reduction surgery.