From the Guidelines
Breast fat necrosis is typically managed conservatively, with an initial approach focusing on pain control and observation, as it is a benign condition that often resolves on its own. The management strategy prioritizes minimizing morbidity and maintaining quality of life, given the benign nature of the condition. Key considerations in managing breast fat necrosis include:
- Pain control with over-the-counter analgesics such as acetaminophen or ibuprofen, as needed, to alleviate discomfort without contributing to unnecessary morbidity 1.
- Application of warm compresses to the affected area to improve blood circulation and promote healing, which can help in reducing the size of the necrotic area and associated symptoms.
- For cases where a large, painful collection of liquefied fat develops, aspiration under ultrasound guidance may be necessary to relieve symptoms and prevent further complications, as suggested by the high negative predictive value (NPV) of ultrasound in evaluating breast lesions 1.
- In situations where malignancy cannot be definitively excluded through imaging, including diagnostic mammography or digital breast tomosynthesis (DBT) for lesion characterization, surgical excision might be recommended to ensure patient safety and prevent potential mortality from delayed diagnosis of a malignant condition.
- Follow-up imaging with mammography or ultrasound is crucial to document stability or resolution of the lesion, ensuring that the condition does not evolve into a more serious issue, and to monitor for any signs of malignancy, given the potential of fat necrosis to mimic breast cancer on imaging and physical examination 1.
From the Research
Management of Breast Fat Necrosis
The management of breast fat necrosis can be approached in the following ways:
- Conservative management with regular clinical and radiological follow-up, and patient reassurance, should be pursued even for large masses, in the absence of concomitant complications 2
- Ultrasound-guided core-biopsy (CB) is a safe, quick and useful test to confirm the diagnosis, making it possible to reassure the patient of the true identity of the lesion, thus avoiding the need for surgical excision or follow-up investigations 3
- Surgical intervention may be necessary in some cases, particularly if fat necrosis is diagnosed early (≤one-month after breast surgery) 2
- Mammography, sonography, and MRI may be used to rule out malignancy and confirm the diagnosis of fat necrosis 4, 5, 6
Diagnostic Approaches
The diagnosis of breast fat necrosis can be made using:
- Mammography, which may show a range of appearances from a lipid cyst to findings suspicious for malignancy, including clustered microcalcifications, a spiculated area of increased opacity, or a focal mass 4
- Sonography, which may show an abnormality in 100% of cases, although 74% may be interpreted as possibly malignant 3
- MRI, which may be used as an adjunct to mammography and sonography to rule out malignancy 5
- Ultrasound-guided core-biopsy (CB), which can confirm the diagnosis and avoid unnecessary surgical excision or follow-up investigations 3
Treatment Considerations
The treatment of breast fat necrosis should be approached on a case-by-case basis, taking into account the size and location of the lesion, as well as the presence of any concomitant complications 2