Fat Necrosis vs. Seroma? What can be done to get rid of them? (Photo)

Question

Hello Doctors, I had a lift surgery on both breasts, reduction on one, and fat transfer to both back in 4/2023. In 2/24 we did a revision for the lift with the same surgeon without any fat transfer. I developed two big lumps in both breasts. Attached ultrasound photos and radiology report. How can we tell for sure if this fat necrosis or seroma? And what would be the technique used to get rid of them as they are big and palpable but no pain. Thank you!

Ajaya Kashyap, MD · Answer

Thank you for your query. Your Radiologist and Plastic surgeon can check the lumps out, although the images look more in favour of seromas. A fine needle aspiration under ultrasound guidance can clarify the situation. All the best!

Ryan Endress, MD · Answer

With the fluid consistency seen on US, it is likely a seroma. At this point, there would be formation of a capsule around any collection, which would take excision to completely eliminate. You could try for aspiration of the fluid and compression, but that is less likely to solve the problem and recurrence is almost a certainty. Thanks and great question!

Elizabeth Kiwanuka, MD, PhD · Answer

Based on your description and the attached ultrasound photos and radiology report, it's crucial to differentiate between fat necrosis and seroma to determine the appropriate treatment plan.
To definitively diagnose whether the lumps are fat necrosis or seroma, your surgeon may recommend further diagnostic tests such as fine needle aspiration (FNA) or biopsy. These procedures can provide samples of the affected tissue, allowing for histological examination to confirm the diagnosis.
As for the technique used to address the lumps, the approach will depend on the diagnosis and the size and location of the lumps. If the lumps are confirmed to be fat necrosis, surgical excision may be necessary to remove the affected tissue. Alternatively, if they are determined to be seromas, drainage procedures such as needle aspiration or surgical drainage may be performed to remove the accumulated fluid.
Since the lumps are palpable but not painful, it's important to discuss with your surgeon the potential risks and benefits of each treatment option, as well as any possible implications for your overall breast aesthetics and function.
I recommend scheduling a follow-up appointment with your surgeon to review the ultrasound findings and radiology report in detail, discuss the diagnostic and treatment options, and formulate a personalized plan tailored to your needs and preferences.

Daniel Barrett, MD · Answer

Dear Charming669067,
I understand your concern. Seroma can be removed using needles and aspiration. However, without a proper assessment, it would be difficult to determine what is 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

Connie Hiers, MD, FACS · Answer

A needle biopsy could be done. With a seroma, only fluid will be present. With tissue necrosis, actual tissue can be removed and examined. The radiologist should be able to do this with a needle. Both may need to be excised. The seroma may have formed a thick wall cavity which may need to be removed.

Fat Necrosis vs. Seroma? What can be done to get rid of them? (Photo)

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Fat Necrosis vs. Seroma? What can be done to get rid of them? (Photo)

Answers (7)

Answer: Fat Necrosis vs. Seroma

Answer: Fat Necrosis vs. Seroma

Answer: Breast

Answer: Breast

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Recommended reading

Everything you need to know about Breast Fat Transfer

Our mission is to create a world where every investment in modern beauty is Worth It.