From the Guidelines
Fat necrosis in the breast is typically managed conservatively with observation and reassurance as it often resolves spontaneously over time. Initial management includes pain control with over-the-counter analgesics such as acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or NSAIDs like ibuprofen (400-600mg every 6-8 hours with food) 1. For persistent or painful lesions, warm compresses applied for 15-20 minutes several times daily may help reduce discomfort and promote resolution.
Diagnostic Approach
Diagnostic confirmation is essential through imaging, with ultrasound being a useful modality in this setting, as supported by studies such as Dashevsky et al and Edeiken et al 1. In cases where ultrasound findings are indeterminate or suggestive of fat necrosis, diagnostic mammography or digital breast tomosynthesis (DBT) may be helpful for lesion characterization and may preclude the need for biopsy if a clearly benign finding such as an oil cyst is identified 1.
Management Considerations
Surgical excision is reserved for cases with persistent symptoms, enlarging lesions, or diagnostic uncertainty despite biopsy. Fat necrosis results from trauma to fatty breast tissue, leading to inflammatory reactions and eventual fibrosis. The condition is benign and typically follows trauma, surgery, or radiation therapy. Patients should be educated about the benign nature of the condition and reassured that it does not increase breast cancer risk, though regular breast cancer screening should continue as recommended for their age and risk factors. Key considerations in management include:
- Conservative management with observation and pain control
- Use of imaging modalities like ultrasound and mammography for diagnostic confirmation
- Reserved use of surgical excision for specific indications
- Patient education on the benign nature of fat necrosis and the importance of continued breast cancer screening.
From the Research
Management of Fat Necrosis in Breast
- Fat necrosis of the breast is a benign entity that can result in unnecessary biopsy of breast lesions 2
- The diagnosis of fat necrosis can be confirmed by ultrasound-guided core biopsy, which is a safe, quick, and useful test to confirm the diagnosis 3
- Imaging by either mammography or ultrasound is often inconclusive, and correlation with clinical history is paramount in evaluating these patients 2
- Fat necrosis can occur after trauma, surgery, biopsy, post-breast reconstruction, post-fat grafting, post-radiotherapy, infection, and duct ectasia, among other conditions 2
- Management of fat necrosis includes aspiration or excision based on a treatment algorithm, and symptoms related to fat necrosis can be significantly improved in most patients 4
Treatment Options
- Asymptomatic or small lesions can be treated conservatively 5
- Oil cyst and moderately sized areas of symptomatic fat necrosis can effectively be treated by aspiration, ultrasound-assisted liposuction, or needle aeration 5
- Calcified and large areas of fat necrosis require excision and debridement of necrotic fat tissue 5
- A new classification system has been proposed to aid the guidance of management of symptomatic fat necrosis 5
Clinical Significance
- Fat necrosis is a common complication of radiotherapy, which rarely requires therapeutic intervention, but can significantly degrade the quality of all modalities of breast imaging 6
- Fat necrosis following autologous fat grafting for breast augmentation can be managed successfully, and its related symptoms can be relieved in most patients 4