Fat Necrosis 12 Months Post-op, DCIS Bilateral Mastectomy?

Question

Good day How likely is it for fat necrosis to occur 12 months post op? I had DCIS in left breast, oestrogen +, nodes clean. I opted to have a bilateral mastectomy. Calcifications found in right breast. Reconstruction with silicone implants behind the chest wall12 months ago. I've discovered a lump as big as a pea in my right breast a week ago. Nothing showed up on the sonar although the dr could feel the lump. When I found DCIS lump, Sonar and mammo didn't pick it up either. Thank you

Heather Richardson, MD, FACS · Answer

Fat necrosis occurs when a fat lobule dies, from either traumatic injury or because its blood supply was cut off. When this happens, it first swells, then becomes tough and enlarged, then eventually starts to shrink and dissolve away. This occurs over months to about a year. As this process evolves, sometimes lumps are felt that then shrink down, becoming harder over time and "suddenly" noticeable, even though surgery was months previously. This happens because as the fat lobule shrinks, the dead cells absorb calcium leaving a safe little "stone" that can has a telltale appearance on ultrasound and x-ray (mammograms). These coarse, chunky calcium deposits tend to look much different from tiny, fine microcalcifications that are associated with abnormal cell overgrowth inside milk ducts and glands that is a red flag signal for possible disease. It should be easy to tell with an exam or an ultrasound what this is, and very easy to take a tiny pinch to be sure if there is any question. We do avoid mammograms in patients who have had mastectomies, with very few exceptions. If this has happened near a lumpectomy or breast reduction site, a mammogram can help with additional information.

C. Bob Basu, MD, MPH, FACS · Answer

Given your breast cancer history, if you are feeling a mass, then this warrants medical attention.  Please see your reconstructive plastic surgeon and/or your oncologist for an evaluation.

Pedro M. Soler, Jr., MD · Answer

It is not unusual for the breast to feel lumpy bumpy after mastectomy with subsequent reconstruction.  From what little information you have provided you seem to be a low risk for recurrence. The typical factors that will increase the likelihood of recurrence include: Lymph node involvement, Tumor size larger than 5 centimeters, Inflammatory breast cancer, No radiation therapy after lumpectomy, Women under age 35, and Positive or close margins in the specimen.

	However, due to the fact that there is a very discreet mass in a post mastectomy patient, I would be inclined to do an excisional biopsy of the lesion. It would be the safe and easy thing to do.

	Good luck.

Robert Whitfield, MD · Answer

Is this near your mastectomy scar?  Could do an excisional biopsy for definitive diagnosis.

Fat Necrosis 12 Months Post-op, DCIS Bilateral Mastectomy?

Answers (4)