Breast Imaging Society, India

Contributed By:

Dr.Tandra Sarkar

Case History:

30years old female presented with complaints of dragging sensation and firm mass in left breast .She has a history of bilateral breast reduction surgery. �On examination : �On physical examination both breasts appear normal , nipple areola complex is well maintained with scar (breast reduction surgery).

Quiz Question:

Post Breast Reduction Surgery Nodular Fat Necrosis

Answer

�On examination : �On physical examination both breasts appear normal , nipple areola complex is well maintained with scar (breast reduction surgery). �On inspection firm mass inner quadrant of left breast . �Bilateral axilla is normal

Discussion

Discussion �It is a pathological process that occurs due to saponification of fat �Benign inflammatory process usually associated with the breast conservation surgery, mamoplasty or breast reduction surgery. �On USG : �There are various stages of fat necrosis following breast surgery �Acute phase(within days) :Increased echogenicity due to edema of fatty tissue �Subacute phase(days to months ) : Ill defined cystic lesions surrounded by edematous fat . �Late phase(1yr or more ):calcified wall with posterior shadowing, spiculated mass with annular rim. MRI: �At STIR sequence fat necrosis appears as hypo intensity (black hole sign ) �T1 and T2 depicts variable kinetics depending on necrosis and fibrosis of mass . �HISTOPATHOLOGY: �Histiocytes, few lymphocytes and a few neutrophils �Background shows protienaceous material �Benign ductal epithelial cells �No granuloma or malignant cells seen.

Findings

Nodular multifocal fat necrosis in left breast in post breast reduction surgery

References

Palpable lumps after mastectomy:Radiologic and Pathological review :RAl Khalilli 2021 �Natural course of fat necrosis after breast reconstruction:BMC cancer 2019 �Multimodality Imaging of fat necrosis of breast by L Saidan 2017. �MRI of fat necrosis of breast :the �black hole �sign at tau inversion recovery .TrimboliRM, Carbonaro LA ,Cartia F, SardenellinF .European Journal of Radiology, July 2011.

November 2022