Fat necrosis in the breast

Case contributed by Dr Garth Kruger

Presentation

Routine screening mammogram images. History of previous open surgical breast biopsy right breast many years before.

Patient Data

Age: 60 years
Gender: Female
Mammography

There are two foci of fat necrosis in this view; one central inferior with a bubbly appearance and a second small focus above the equator deep to the skin. The second focus has begun to calcify. 

Mammography

One year later

Both areas of fat necrosis have calcified. 

Case Discussion

With needle biopsies mostly used for diagnosis these days, we are seeing less and less gross fat necrosis compared with 20 years ago. The protean manifestations of fat necrosis on mammogram and ultrasound can confuse if you are not aware of the diagnosis, the way it presents and how it can change with time.

In my experience fat necrosis changes with time and can do so quite remarkably on serial follow up imaging. The area is usually related to open surgery or direct breast trauma. Potential confusion arises when the necrotic fat starts to calcify and initially the calcifications may even mimic malignant breast calcifications. The process of calcification can continue long after surgery. I have seen cases where the calcification has changes 2 or 3 years after the surgery. The ultrasound imaging can be just as confusing unless you have a heads up about the surgery.

The calcification usually starts as a peripheral curvilinear thin eggshell rim and then progresses from there.

Also be aware that the area of fat necrosis can be quite a way from the surgical scar in some cases.

As always, compare with previous and read the technologist's sheet. The surgery is marked out for you.

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Case information

rID: 18559
Case created: 12th Jul 2012
Last edited: 12th May 2016
System: Breast
Inclusion in quiz mode: Included

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