Fat necrosis of the breast: mammographic, sonographic, computed tomography, and magnetic resonance imaging findings

Chala, Luciano Fernandes; Barros, Nestor de; Moraes, Paula; Endo, Erica; Kim, Su Jin; Pincerato, Kátia Maciel; Carvalho, Filomena Marino; Cerri, Giovanni G.

doi:10.1067/j.cpradiol.2004.01.001

Cited by 112 publications

(31 citation statements)

References 10 publications

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“…When fibrosis is present but the radiolucent fat is not completely replaced, the oil cyst may have thickened, irregular, spiculated, or ill-defined walls. Fibrosis may lead to replacement of the radiolucent necrotic fat, resulting in the appearance of a focal asymmetric density, a focal dense mass, or an irregular spiculated mass on mammography [ 12 ]. Oil cysts with fat-fluid levels or serous-hemorrhagic contents, collapsed cysts, and cysts containing spherical densities are all atypical features of fat necrosis.…”

Section: Imaging Findings Of Fat Necrosismentioning

confidence: 99%

“…As mentioned before, fat necrosis is usually isointense to fat elsewhere in the breast, a key to diagnosis ( Figure 6 ). In cases where fat necrosis is not isointense, the T1-weighted signal may be lower than fat elsewhere in the breast [ 12 ]. Another useful technique for ruling out necrotic tumors is using unenhanced non-fat-saturated T1-weighted images to evaluate the degree of lipid cyst formation, looking for a thin rim of enhancement [ 17 ].…”

Section: Imaging Findings Of Fat Necrosismentioning

confidence: 99%

“…The CT appearance is based on the main components found in fat necrosis: liquefied fat, fibrosis, and inflammation. Liquefied fat would present on CT as low attenuation coefficients, fibrosis would present as soft tissue coefficients similar to fibroglandular tissue or linear densities resembling fibrous bands, and inflammation would present with enhancement after contrast injection [ 12 ]. Calcifications typically are not evident until later in the evolution of fat necrosis when they become large in size.…”

Section: Imaging Findings Of Fat Necrosismentioning

confidence: 99%

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Fat Necrosis of the Breast: A Pictorial Review of the Mammographic, Ultrasound, CT, and MRI Findings with Histopathologic Correlation

Kerridge

Kryvenko

Thompson

et al. 2015

Radiology Research and Practice

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Fat necrosis of the breast is a challenging diagnosis due to the various appearances on mammography, ultrasound, CT, PET-CT, and MRI. Although mammography is more specific, ultrasound is a very important tool in making the diagnosis of fat necrosis. MRI has a wide spectrum of findings for fat necrosis and the appearance is the result of the amount of the inflammatory reaction, the amount of liquefied fat, and the degree of fibrosis. While CT and PET-CT are not first line imaging examinations for the diagnosis of breast cancer or fat necrosis, they are frequently performed in the surveillance and staging of disease. Knowledge of how fat necrosis presents on these additional imaging techniques is important to prevent misinterpretation of the imaging findings. Gross and microscopic appearances of fat necrosis depend on the age of the lesion; the histologic examination of fat necrosis is usually straightforward. Knowledge of the variable appearances of fat necrosis on a vast array of imaging modalities will enhance a radiologist's accuracy in the analysis and interpretation of fat necrosis versus other diagnoses.

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Section: Imaging Findings Of Fat Necrosismentioning

confidence: 99%

Section: Imaging Findings Of Fat Necrosismentioning

confidence: 99%

Section: Imaging Findings Of Fat Necrosismentioning

confidence: 99%

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Fat Necrosis of the Breast: A Pictorial Review of the Mammographic, Ultrasound, CT, and MRI Findings with Histopathologic Correlation

Kerridge

Kryvenko

Thompson

et al. 2015

Radiology Research and Practice

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“…Contour irregularities and volume deficits in both autologous and implant-based reconstructions can both be addressed with autologous fat transfer 4 . The concept was initially met with considerable skepticism, given concerns over differentiating between fat necrosis and cancer recurrence on imaging 5 , and over possible stimulation of cancer development by transferred fat 6–7 . However, subsequent studies have failed to validate either concern 8–11 .…”

Section: Introductionmentioning

confidence: 99%

Association of Fat Grafting With Patient-Reported Outcomes in Postmastectomy Breast Reconstruction

Bennett

Kim

et al. 2017

JAMA Surg

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Importance Fat grafting has proven to be a useful adjunct to breast reconstruction for the treatment of contour irregularities and volume deficits, but the proposed FDA regulations may severely limit the ability of plastic surgeons to continue its use in this clinical context. Objective To determine if fat grafting has an effect on patient-reported outcomes (PROs) in breast reconstruction patients. Design Longitudinal, multicenter, prospective cohort study conducted between February 2012 and July 2016. Setting Conducted at the 11 study sites associated with the Mastectomy Reconstruction Outcomes Consortium (MROC) study. Participants Eligible patients included women 18 years and older presenting for breast reconstruction following mastectomy with at least two years of follow-up. All primary procedure types (implant- and flap-based) were eligible. Patients were excluded if they had not completed breast mound reconstruction by one year after mastectomy. Interventions Fat grafting as an adjunct to breast reconstruction. Main outcomes and measures Primary end points were patient-reported outcome measures as assessed by the validated BREAST-Q, with higher scores indicating better health-related quality of life. Survey subscales included breast satisfaction, as well as psychosocial, physical, and sexual well-being. Patient-reported outcomes were compared between fat grafted and non-fat grafted patients. Results A total of 2,048 women were included, with 165 undergoing fat grafting between years one and two. One year postoperatively, patients who later underwent fat grafting reported significantly lower breast satisfaction (adjusted mean difference (AMD) = −4.74, CI −8.21 to −1.28, p=0.008), psychosocial well-being (AMD = −3.87, CI −7.33 to −0.40, p=0.029), and sexual well-being (AMD = −5.59, CI −9.70 to −1.47, p=0.008), compared to those who did not receive subsequent fat grafting. Following fat grafting, the fat grafted cohort reported similar breast satisfaction (AMD = −0.68, CI −4.42 to 3.06, p=0.719), psychosocial well-being (AMD = −0.59, CI −3.92 to 2.74, p=0.728), and sexual well-being (AMD = −2.94, CI −7.01 to 1.12, p=0.154) at two years postoperatively. Conclusions and relevance Fat grafting improves breast satisfaction, psychosocial well-being, and sexual well-being in breast reconstruction patients.

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“…It is a nonsuppurative inflammatory change of adipose tissue. On imaging, fat necrosis shows a wide variety of presentations (3)(4)(5). Mammographically, it could manifest as lipid cysts, coarse calcifications, focal asymmetries, microcalcifications, radiolucent or even spiculated masses (6,7).…”

Section: Introductionmentioning

confidence: 99%

Fat Necrosis in the Post-Surgical Breast: Dependence on Adjuvant Treatment and Morphology on Digital Mammography

Preibsch¹,

Wallis

2019

Iran J Radiol

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Background: Fat necrosis is a common finding after trauma or surgery of the breast. There are various presentations on imaging and differentiation from malignancy can be challenging. Objectives: To analyze early signs of fat necrosis on postoperative mammograms after the excision of benign and malignant findings in accordance to modern adjuvant treatment. Patients and Methods: A retrospective analysis was performed as part of an audit. Mammograms of 39 patients, who underwent surgical excision of benign disease, and 81 patients with cancer surgery, were reviewed. Adjuvant therapy, such as radiotherapy, chemotherapy and hormonal treatment, was noted. Results: Mean patient age was 54.6 ± 6.5 years in the benign and 59.8 ± 7.8 years in the malignant group. Mean lesion size did not differ between the groups (P = 0.735). Development of fat necrosis on mammography follow-up was observed in 12.8% (5/39) of the patients in the benign and in 32.1% (26/81) of the patients in the malignant group (P = 0.024). Mean follow-up time until the first sign of fat necrosis was 2.6 years in the benign group and 2.0 years in the malignant group (P = 0.187). With radiation therapy ± hormonal treatment 25 of 75 patients (33.3%) developed fat necrosis. Hormonal treatment significantly influenced the development of fat necrosis in the malignant group (odds ratio [OR]: 0.231; P = 0.029). Four of 16 patients (25.0%) having radiation and chemotherapy developed fat necrosis. Conclusion: Fat necrosis development was observed significantly more often in patients after breast cancer surgery and modern adjuvant treatment compared to benign breast surgery. However, hormonal adjuvant treatment seemed to lower the chance of fat necrosis development.

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Fat necrosis of the breast: mammographic, sonographic, computed tomography, and magnetic resonance imaging findings

Cited by 112 publications

References 10 publications

Fat Necrosis of the Breast: A Pictorial Review of the Mammographic, Ultrasound, CT, and MRI Findings with Histopathologic Correlation

Fat Necrosis of the Breast: A Pictorial Review of the Mammographic, Ultrasound, CT, and MRI Findings with Histopathologic Correlation

Association of Fat Grafting With Patient-Reported Outcomes in Postmastectomy Breast Reconstruction

Fat Necrosis in the Post-Surgical Breast: Dependence on Adjuvant Treatment and Morphology on Digital Mammography

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