Findings
Nodular multifocal fat necrosis in left breast in post breast reduction surgery
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.
Reference
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.
