We recently reported the prevalence of atypical proliferative lesions (APL) in reduction mammoplasty specimens from patients that were treated mainly for macromastia with no known history of breast cancer. The current study is to investigate the prevalence of APLs in breast reduction specimens from patients with a history of breast cancer and compare it to that from patients without a history of breast cancer. A retrospective chart review of pathology records on patients that underwent reduction mammoplasty from 2006 to 2012 generated 179 cases. Laterality, specimen weight, number of blocks submitted and presence of APL were recorded and analyzed. We defined APL as invasive carcinoma, ductal (DCIS) or lobular carcinoma in situ, atypical ductal or lobular hyperplasia (ADH or ALH), and flat epithelial atypia (FEA). The presence of papillomas, radial scars and fibroadenomas were also recorded. At least 1 APL was identified in 23 (12.8%) of 179 specimens including invasive lobular carcinoma (n = 3), DCIS (n = 1), ADH/FEA (n = 9) and lobular carcinoma in situ/ALH (n = 10). The most common APL in this cohort was lobular neoplasia (5.6%) followed by ADH and FEA (5.0%). Invasive carcinoma and DCIS was identified in 2.3% of this cohort. In conclusion, the frequency of detection of APLs in patients with history of breast cancer is significantly higher than that in patients without history of breast cancer (12.8% versus 4.3%). Our data assessed the prevalence of APLs in this setting and, therefore, provide new information on decision-making for contralateral breast reduction in patients with history of breast cancer.