What are common signs of fat necrosis and how common is this after a breast reduction or breast lift?

Question

I just wanted to know what the common signs of fat necrosis are? and how common is it after a reduction/lift?

Ronald J. Edelson, MD · Answer

Fat necrosis in a mild form is common after breast reduction. Some of the fat liquifies and can drain out the incision under the breast and also make the breast red. It heals on it own and is usually not a major problem.

Semih Yildiz, MD, FEPOBRAS · Answer

Fat necrosis most often shows up as a firm lump or area of hardness in the breast. It may be tender at first, sometimes with bruising, mild skin indentation, a small contour change, or an oily cyst-like area. It can also be painless, so any new lump after breast surgery should be checked rather than assumed to be harmless.

After a breast reduction or lift, fat necrosis is not the most common complication, but it is a known one. The risk is higher when a large amount of tissue is moved or removed, when the blood supply to an area is under stress, and in patients who smoke or have healing risk factors. Many small areas soften over time, but a persistent, growing, painful, red, or draining area should be evaluated by your surgeon.

Your surgeon may examine you and, if needed, order an ultrasound or mammogram to distinguish fat necrosis from a fluid collection, infection, scar tissue, or an unrelated breast mass. If there is spreading redness, fever, worsening pain, drainage, or the breast is becoming hot and swollen, seek same-day urgent care or contact your surgical team immediately.

Elizabeth Kiwanuka, MD, PhD · Answer

Fat necrosis is a condition that can occur after breast reduction or breast lift surgeries, although it is not extremely common. It happens when fatty tissue in the breast gets damaged and forms firm, round lumps. The common signs of fat necrosis include painless, round, firm lumps in the breast, skin that appears red or bruised, and sometimes, an oily or milky discharge if the lump is close to the skin surface. In some cases, the affected area might feel tender or painful. Fat necrosis can vary in size and may sometimes be mistaken for a breast cancer lump, which is why it's important to have any new lumps evaluated by a healthcare professional. These lumps typically form within a few weeks or months post-surgery and can resolve on their own over time. However, in some cases, medical intervention may be necessary. The likelihood of developing fat necrosis depends on various factors, including the extent of the surgery, individual healing processes, and the techniques used by the surgeon.

Dallas Buchanan, MD · Answer

Thank you for your questions. In general fat necrosis can present early with wound healing issues of the overlying skin from lack of blood flow. However, the more common presentation is later in the healing phase (3-6 months) when you start to feel hardened areas of the breast that remain while other areas heal and soften. I would say that this is present in 5% or less of most cases. 
Hope this helps.
Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Daniel Barrett, MD · Answer

Dear SueHS,
fat necrosis after breast lift and reduction is uncommon. In most cases, it occurs after fat transfer. I understand your concern. However, without a proper assessment, it would be difficult to determine what went wrong. It is best that you visit your plastic surgeon for further assessment or ask for a second opinion. Only after a thorough examination, you can get proper recommendations and advice.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

Jon S. Wilensky, MD · Answer

Fat necrosis is a condition that can occur after breast surgery, including breast reduction or breast lift procedures. It happens when fatty tissue in the breast loses its blood supply and dies, leading to the formation of firm lumps or areas of scar tissue within the breast. While fat necrosis isn't typically harmful, it can cause discomfort and may affect the appearance of the breast.Here are some common signs of fat necrosis after breast surgery:1. Firm Lumps or Masses: Fat necrosis often presents as firm lumps or masses within the breast tissue. These lumps may feel similar to a breast tumor and can be concerning for patients.2. Pain or Discomfort: Fat necrosis can cause localized pain or discomfort in the affected area of the breast. This discomfort may be persistent or intermittent and can range from mild to moderate in severity.3. Changes in Breast Shape or Size: As fat necrosis heals, it can lead to changes in the shape or size of the breast. This may result in asymmetry between the breasts or alterations in breast contour.4. Skin Changes: In some cases, fat necrosis may cause changes in the overlying skin, such as dimpling, puckering, or retraction. These skin changes can affect the appearance of the breast.5. Imaging Findings: Fat necrosis may be detected on imaging studies, such as mammograms or breast ultrasound. On imaging, fat necrosis may appear as irregular masses or areas of calcification within the breast tissue.It's important to note that fat necrosis is relatively common after breast surgery, including breast reduction or breast lift procedures. The exact incidence of fat necrosis can vary depending on factors such as the surgical technique used, the extent of tissue manipulation, and individual patient characteristics. While fat necrosis can be concerning for patients, it is typically not associated with an increased risk of breast cancer.If you experience signs or symptoms of fat necrosis after breast surgery, it's important to follow up with your plastic surgeon for evaluation and management. In many cases, fat necrosis will resolve on its own over time, but your plastic surgeon may recommend additional imaging studies or interventions if necessary.

Shana Kalaria, MD · Answer

Detectable signs of fat necrosis are pain, a lump, redness, and tenderness of the breast. Some fat necrosis happens with both breast reduction and breast lift, but it rarely results in symptoms. Please visit with a board-certified plastic surgeon. Good luck!

Ahmad H. Ahmadi, MD · Answer

Fat necrosis after breast reduction is uncommon.  In the case of skin necrosis, one can be sure there is some underlying fat necrosis as well.  Later on, necrotic fat becomes hardened, and one may be able to feel it.

Connie Hiers, MD, FACS · Answer

A reduction, especially a large one, does carry a small risk of fat necrosis. Typically, you will feel a hard ball of scar tissue, especially near or behind the scars. this can be removed later. Fat necrosis is uncommon with just a lift.

Douglas Taranow, DO, FACOS · Answer

Fat necrosis is very rare after breast lift and not too common following breast reduction procedures.  Most commonly, there may be a firm ball or nodule which may or may not be painful, bruising, dimpling and even increased WBC count (WBC-white blood cell count on standard blood tests)

What are common signs of fat necrosis and how common is this after a breast reduction or breast lift?

Answers (10)

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