Delayed development of enhancement in fat necrosis after breast conservation therapy: a potential pitfall of MR imaging of the breast.
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Delayed development of enhancement in fat necrosis after breast conservation therapy: a potential pitfall of MR imaging of the breast.B Solomon, S Orel, C Reynolds and M SchnallAudio Available | ShareKeywords:
Fat necrosis
Breast imaging
Nodular-cystic fat necrosis, which is also called encapsulated fat necrosis, is a mobile subcutaneous nodule and histologically reveals fat necrosis encapsulated by fibrous connective tissue. In Japan, many cases have been reported, and there are some opinions that diabetes mellitus and systemic corticosteroid therapy cause this condition. The author found that out of 147 Japanese patients reported from 1982 up to 2015, 9 had the former and 23 received the latter. Systemic corticosteroid therapy may be responsible for nodular-cystic fat necrosis.
Fat necrosis
Subcutaneous fat
Nodule (geology)
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Coagulative necrosis
Fat necrosis
Acinar cell
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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 2–3years.
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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.
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Surgical oncology
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A 56-year-old woman receiving Depixol injections for schizophrenia presented with two separate episodes of breast fat necrosis with no identifiable cause. It is postulated that the fat necrosis could be as of a result of the Depixol injections, where this drug is taken up into the breast fat and subsequently rapidly hydrolysed resulting in fat necrosis.
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症例は37歳の女性。初診の約6年前, 胸部左側に2∼3個の皮下結節が認められたが放置していた。次第に増加してきたため手術目的で北九州市立医療センター皮膚科を受診した。結節出現3年後に同部に鈍的外傷を受け圧痛が出現した。局麻下に直径3∼20mmの結節8個を摘出した。各結節は境界明瞭, 黄白色球形で可動性良好であったが, 最大の結節は周囲組織と癒着していた。病理組織学的には, 厚い線維性被膜で被包された変性脂肪組織からなり, 脂肪壊死, 石灰化, 炎症性細胞浸潤などを伴っていた。自験例は肉眼的および病理組織学的所見より, 1977年に報告されたnodular-cystic fat necrosis1), および, その後報告されたmobile encapsulated lipoma2), posttraumatic fat degeneration and herniation, nodular fat necrosis3), encapsulated necrosis on the legs showing a changing number of nodules4), encapsulated fat necrosis5)と同一の疾患と考えられた。本疾患に対していくつかの疾患名が提唱されているが, 本疾患の本態は“fat necrosis”であり“lipoma”ではないこと, 自験例および文献的検索で“cystic”ではない結節や“mobile”ではない結節が認められたこと, 下腿以外の部位にも結節が認められること, また膵疾患に関連するいわゆる“nodular fat necrosis”とは全く異なる疾患であり紛らわしいことから, encapsulated fat necrosis5)という疾患名が最も適切と考えた。
Fat necrosis
Fat accumulation
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One purported advantage of the free transverse rectus abdominis musculocutaneous (TRAM) flap for breast reconstruction is that, compared with the conventional TRAM flap, it has a better blood supply and therefore a lower incidence of fat necrosis. We tested this claim by reviewing the incidence of fat necrosis, both clinically and mammographically, in a group of 110 patients with 116 TRAM flap breast reconstructions who had undergone mammography of their reconstructed breasts. Of the 49 breasts reconstructed with free TRAM flaps, 4 (8.2 percent) had clinically evident fat necrosis, and 1 (2.0 percent) had fat necrosis that was detectable by mammography. Of the 67 breasts reconstructed with conventional TRAM flaps, 18 (26.9 percent) had clinically detectable fat necrosis, and 9 (13.4 percent) had fat necrosis that was detectable mammographically. Both of these differences were statistically significant (p = 0.0113 for clinical fat necrosis; p = 0.031 for mammographic fat necrosis). Fat necrosis was more common in patients who were obese or had a history of smoking, but neither association was statistically significant. We conclude that the use of the free TRAM flap reduces the incidence of fat necrosis in the reconstructed breast.
Fat necrosis
Rectus abdominis muscle
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