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. 2021 Feb 16;21(1):166.
doi: 10.1186/s12885-021-07881-x.

Natural course of fat necrosis after breast reconstruction: a 10-year follow-up study

Jeeyeon Lee  1 , Ho Yong Park  1 , Wan Wook Kim  1 , Jeong Ju Lee  2 , Hee Jung Keum  1 , Jung Dug Yang  3 , Jeong Woo Lee  4 , Joon Seok Lee  3 , Jin Hyang Jung  5
Affiliations

Natural course of fat necrosis after breast reconstruction: a 10-year follow-up study

Jeeyeon Lee et al. BMC Cancer. .

Abstract

Background: Although fat necrosis is a minor postoperative complication after breast reconstruction, occasionally it mimics to tumor recurrence in patients with breast cancer. Therefore, the surgeon should distinguish between benign fat necrosis and true local recurrence. The authors evaluated the clinical characteristics of fat necrosis after breast reconstruction and investigated the natural course of fat necrosis.

Methods: Between 2007 and 2013, a total of 362 patients underwent breast reconstruction after partial or total mastectomy for breast cancer in Kyungpook National University Hospital. Clinicopathologic characteristics and the occurrence of fat necrosis were assessed during surveillance for 10 years of mean follow-up period.

Results: There were 42 cases (11.6%) of fat necrosis after breast reconstruction with partial or total mastectomy which were confirmed by needle or excision biopsy. The fat necrosis was resolved after a mean period of 45.9 months (SD, ± 42.1) and 26 cases (61.9%) of fat necrosis were almost completely resolved (less than 5 mm) during 10-year follow-up period.

Conclusion: Based on the natural course of fat necrosis, the fat necrosis after breast reconstruction can be only monitored, if pathologic confirmation was done. More than half of the cases will be resolved within 2-3 years.

Keywords: Breast; Breast reconstruction; Carcinoma; Fat necrosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
a-c Mammographic findings of fat necrosis after breast reconstruction. Dystrophic calcification (arrow heads) and architectural distortion (arrows) are common findings in the mammography of fat necrosis
Fig. 2
Fig. 2
Ultrasonographic findings of fat necrosis after breast reconstruction. a, b A simple or fat-containing complex cyst is a typical ultrasonographic finding of fat necrosis. c, d Sometimes the fat necrosis mimics tumor recurrence in ultrasonography as a hypoechoic nodule with irregular margins. In these cases, pathologic confirmation is necessary to distinguish it from tumor recurrence
Fig. 3
Fig. 3
Consecutive changes in fat necrosis after breast reconstruction in ultrasonography. a Initially, fat necrosis was detected after 6 months from surgery as a mass of around 4 cm with an indistinct margin in the mid-outer portion of the right breast. Needle biopsy was performed, and fat necrosis was confirmed pathologically. b After 1 year from the detection of fat necrosis, the volume of the necrotic mass was decreased. And calcification appeared at the center of the fat necrosis area (arrowhead). c After 2 year from the occurrence of fat necrosis, the mass was shrunk further. d Although the mass became much smaller over time, calcification (arrowhead) remained at the fat necrosis area
Fig. 4
Fig. 4
Sizes of the necrotic mass after breast reconstruction. The mean size of the necrotic mass was decreased by half during the first 2 years from the occurrence of fat necrosis, and more than 60% of fat necrosis cases were completely resolved during the 10-year follow-up period
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