What are the solutions for large fat necrosis in breast from fat transfer

Question

I had a breast fat transfer and it's been about a year and my left breast has a large fat necrosis that takes up a lot of my upper breast. I don't feel pain but sometimes uncomfortable from it. What're some solutions to this?? Will I have to have an invasive surgery and cut into my whole breast? Could it cover over possible breast cancer in the future making it non detectable?? Not sure if these are stupid questions but I'm scared! Need some peace of mind

Alan Gonzalez, MD, FACS · Answer

Hello @penguinmaster1001, thank you for your question.   Fat necrosis following fat transfer to the breast is a possible consequence that usually manifests as a solid, painless mass in the breast. You should consult with your surgeon so that you can receive the best therapy possible; he can provide you specific recommendations according to your case. The aproach to fat necrosis is determined by the size, location, symptoms of the patient, and personal preference. Best wishes! Alan Gonzalez MD, FACS.  American Society of Plastic Surgery Member (ASPS), International Federation for Adipose Therapeutics and Science Member (IFATS), American Society of Plastic Surgery Member (ASPS), Colombian Society of Plastic Surgery member (SCCP).

John Michael Thomassen, MD · Answer

Probably the best treatment would be direct excision.  This can be done from a prior scar to avoid new scarring.

Eric Wright, MD · Answer

If the firm areas are still present after a year, I would recommend obtaining imaging for further evaluation. Fat necrosis has specific findings on imaging. This may also help provide information regarding the size and consistency of firm area. Based upon this, further intervention can be discussed. I would follow up with your surgeon to discuss options at this point.

Dr. Eric J. Wright

Dr. Eric J. Wright

Daniel Barrett, MD · Answer

Dear penguinmaster1001,
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, MDCertified, American Board of Plastic SurgeryMember, American Society of Plastic SurgeryMember, American Society of Aesthetic Plastic Surgery

Ronald J. Edelson, MD · Answer

It depends on your symptoms and examination. I would go back to the surgeon who did it originally. Probably do nothing as long as it’s not infected

Connie Hiers, MD, FACS · Answer

With a large area of fat necrosis, the necrotic hard tissue can be surgically removed. Liposuction does not work well for this. with this gone, your breast will feel softer and be easier to screen with futures mammograms.

Douglas Taranow, DO, FACOS · Answer

If your mass (lump) is not symptomatic, then leave it alone.  If you dislike the upper pole fullness where the fat necrosis mass is, consider either : Liposuction (if possible) to remove the central necrotic fat that is many times found in the center of the mass, or surgical excision (leaves a scar directly over the mass)

Mats Hagstrom, MD (license on probation) · Answer

Delivering consistent quality, Liposuction and difficult than most people realize. The number of providers truly mastered these procedures are in a small minority. This should happen if the procedure is done correctly, it should not leave noticeable firm lumps. This indicates that poor technique was used during the procedure without properly stratifying the grafted fat.
There’s no clear guidelines for a fat necrosis should be removed or not. A lot depends on how much it bothers you and what you’re willing to go through to have it removed. It generally requires open excision, and may lead to a deformity. Palpable nodules from fat necrosis could potentially obscure finding an early breast cancer on examination. Fat transfer can also create calcifications seen on mammograms.
There are no clear guidelines in regards to cancer screening in regards to how this should be managed. Each plastic surgeon. Patient may have the wrong preferences. I suggest you follow up with the provider who did the procedure and talk to him or her about your concerns. Alternatively, you can schedule a second opinion in person consultations with other plastic surgeons in your community. Make sure you cancel only with plastic surgeons, whoever sufficient experience with Liposuction and fat transfer.
For a second opinion, consultations, I recommend patients come prepared, bringing with them all before, and after pictures, and a copy of your operative report. These can be obtained from your previous provider upon request.
Best,
Mats Hagstrom, MD

What are the solutions for large fat necrosis in breast from fat transfer

Answers (8)

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